Provider Demographics
NPI:1619356680
Name:YOUSO, TIMOTHY A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:YOUSO
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 1:5695 HIGHWAY 95 N
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-9646
Mailing Address - Country:US
Mailing Address - Phone:928-764-3737
Mailing Address - Fax:
Practice Address - Street 1:5695 HIGHWAY 95 N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-9646
Practice Address - Country:US
Practice Address - Phone:928-764-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0316934OtherNABP
AZ1164449377OtherNPI
AZBW2116677OtherDEA