Provider Demographics
NPI:1063485753
Name:KIRK, TIMOTHY J (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:KIRK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 LINZDEN PL
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-2202
Mailing Address - Country:US
Mailing Address - Phone:734-847-6788
Mailing Address - Fax:
Practice Address - Street 1:8946 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1653
Practice Address - Country:US
Practice Address - Phone:734-847-6788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist