Basic Information
| Provider Information | |||||||||
| NPI: | 1285610642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGFORD | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | PHARM.D., BCPS, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 S CHILOQUIN BLVD | ||||||||
| Address2: | PO BOX 490 | ||||||||
| City: | CHILOQUIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976246747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418821487 | ||||||||
| FaxNumber: | 5417833554 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 S CHILOQUIN BLVD | ||||||||
| Address2: | |||||||||
| City: | CHILOQUIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976246747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418821487 | ||||||||
| FaxNumber: | 5417833554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 01/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | RPH-0010620 | OR | N | Pharmacy Service Providers | Pharmacist | 1835P0018X | RPH-0010620 | OR | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.