Provider Demographics
NPI:1265028385
Name:TIMOFEEVA, MARIA MAKSIMOVNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MAKSIMOVNA
Last Name:TIMOFEEVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 CLIFF LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2492
Mailing Address - Country:US
Mailing Address - Phone:651-454-5150
Mailing Address - Fax:
Practice Address - Street 1:1940 CLIFF LAKE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2492
Practice Address - Country:US
Practice Address - Phone:651-454-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55191183500000X
MN124160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist