Provider Demographics
NPI:1144408014
Name:CALDER, TIMOTHY EARL (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EARL
Last Name:CALDER
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 1:981 N SHAWANO ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:WI
Mailing Address - Zip Code:54961-9380
Mailing Address - Country:US
Mailing Address - Phone:920-982-5189
Mailing Address - Fax:
Practice Address - Street 1:981 N SHAWANO ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9380
Practice Address - Country:US
Practice Address - Phone:920-982-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11010-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist