Provider Demographics
NPI:1053697664
Name:FAHY, TIMOTHY THOMAS (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:THOMAS
Last Name:FAHY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1135
Mailing Address - Country:US
Mailing Address - Phone:303-532-3453
Mailing Address - Fax:303-532-3460
Practice Address - Street 1:2320 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1135
Practice Address - Country:US
Practice Address - Phone:303-532-3453
Practice Address - Fax:303-532-3460
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist