Provider Demographics
NPI:1417231838
Name:HABERERN, TIMOTHY W
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:W
Last Name:HABERERN
Suffix:
Gender:M
Credentials:
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 335
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-0335
Mailing Address - Country:US
Mailing Address - Phone:207-288-2222
Mailing Address - Fax:
Practice Address - Street 1:34 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1810
Practice Address - Country:US
Practice Address - Phone:207-288-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist