Active NPI
Demarko Ren Timmons
- Pharmacist
- Saint Louis, MO
National Provider Identifier
1093319261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2020025888
- Practice address
- 7320 Gravois Ave
Saint Louis, MO 63116-1021 - Phone
- (314) 351-6728
- NPI assigned
- Nov 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2020025888 | MO | Primary |
Addresses
Primary practice location
7320 Gravois Ave
Saint Louis, MO 63116-1021
Mailing address
11025 Saint Girard LN
Saint Ann, MO 63074-1213
Phone (314) 236-1268
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020025888 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri CVS Pharmacy LLC | Past | Accepting new patients | |
| Missouri CVS Pharmacy, L.L.C. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606521600000",
"number": "1093319261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11025 SAINT GIRARD LN",
"city": "SAINT ANN",
"state": "MO",
"postal_code": "630741213",
"telephone_number": "314-236-1268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7320 GRAVOIS AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631161021",
"telephone_number": "314-351-6728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMMONS",
"first_name": "DEMARKO",
"middle_name": "REN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-28",
"last_updated": "2020-11-28",
"certification_date": "2020-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2020025888",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.