Timothy Widjaja, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

90387 Issued in CA

Practice address

4067 Peralta Blvd
Fremont, CA 94536-4849

Phone

(510) 793-5096

NPI assigned

Nov 21, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

Practice roles

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.

• Hallers LTC Pharmacy, Inc.

  • Long Term Care Pharmacy
  • Fremont, CA
  • NPI 1366598161
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1659196848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4067 PERALTA BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364849",
            "telephone_number": "510-793-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4067 PERALTA BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945364849",
            "telephone_number": "510-793-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDJAJA",
        "first_name": "TIMOTHY",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-21",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "90387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garland White
• John Richard White, PH.D.
• Linda M White, R.N.
• Suzanne Casey White, FNP
• Damion Whittington
• Wendy Wigger
• Charlette Shy Wiggins-Gurich
• Cara Wiggins
• Nicole Wilberding
• Gina Wilburn, LPC, LMFT

• Pharmacist in Fremont, CA
• Providers in Fremont, CA by specialty
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.