Provider Demographics
NPI:1013351378
Name:WIRTH, TIMOTHY EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:WIRTH
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 1:1601 PACKER ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1861
Mailing Address - Country:US
Mailing Address - Phone:570-980-9340
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH STREET
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-321-3083
Practice Address - Fax:570-321-3231
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451491183500000X
OH03233117183500000X
MA235059183500000X
NY059317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist