Provider Demographics
NPI:1588810089
Name:CERNOHOUS, TIMOTHY MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:CERNOHOUS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 KIRBY DR
Mailing Address - Street 2:103 KIRBY STUDENT CENTER
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-3085
Mailing Address - Country:US
Mailing Address - Phone:218-726-6757
Mailing Address - Fax:218-726-6751
Practice Address - Street 1:1120 KIRBY DR
Practice Address - Street 2:103 KIRBY STUDENT CENTER
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-3085
Practice Address - Country:US
Practice Address - Phone:218-726-6757
Practice Address - Fax:218-726-6751
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist