Provider Demographics
NPI:1407487176
Name:HAINES, TIMOTHY (PHARM D)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HAINES
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1419
Mailing Address - Country:US
Mailing Address - Phone:574-238-5159
Mailing Address - Fax:
Practice Address - Street 1:1249 DEXTER ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1168
Practice Address - Country:US
Practice Address - Phone:734-439-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021811A183500000X
MI5302046353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist