Provider Demographics
NPI:1407299175
Name:STEFANKO, TIMOTHY EDMUND (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EDMUND
Last Name:STEFANKO
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 1:508 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3307
Mailing Address - Country:US
Mailing Address - Phone:970-565-6466
Mailing Address - Fax:970-565-2152
Practice Address - Street 1:508 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3307
Practice Address - Country:US
Practice Address - Phone:970-565-6466
Practice Address - Fax:970-565-2152
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist