Provider Demographics
NPI:1710130091
Name:CARD, TIMOTHY G (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:CARD
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 1:342 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4127
Mailing Address - Country:US
Mailing Address - Phone:315-455-7925
Mailing Address - Fax:315-455-6128
Practice Address - Street 1:342 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4127
Practice Address - Country:US
Practice Address - Phone:315-455-7925
Practice Address - Fax:315-455-6128
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist