Provider Demographics
NPI:1245411313
Name:STIFTER, TIMOTHY F (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:STIFTER
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:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1041
Mailing Address - Country:US
Mailing Address - Phone:716-474-8152
Mailing Address - Fax:
Practice Address - Street 1:629 S UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3953
Practice Address - Country:US
Practice Address - Phone:716-474-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist