Individual provider Active NPI

Marybeth Timian, RPH

  • Pharmacist
  • Syracuse, NY
National Provider Identifier
1902138019
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
41220 Issued in NY
Practice address
922 Spencer St
Syracuse, NY 13204-1137
Phone
(315) 492-1964
Fax
(315) 469-9741
NPI assigned
Feb 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 41220 NY Primary

Addresses

Primary practice location

922 Spencer St
Syracuse, NY 13204-1137

Mailing address

3051 Mohawk St
Sauquoit, NY 13456-2907
Phone (315) 768-7226

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
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
41220NYMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1902138019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 MOHAWK ST",
            "city": "SAUQUOIT",
            "state": "NY",
            "postal_code": "134562907",
            "telephone_number": "315-768-7226",
            "fax_number": "315-724-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 SPENCER ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132041137",
            "telephone_number": "315-492-1964",
            "fax_number": "315-469-9741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMIAN",
        "first_name": "MARYBETH",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-01",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "41220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.