Provider Demographics
NPI:1023232469
Name:TIBBE, MARGERY LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARGERY
Middle Name:LYNN
Last Name:TIBBE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-9745
Mailing Address - Country:US
Mailing Address - Phone:231-652-1009
Mailing Address - Fax:
Practice Address - Street 1:40 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8005
Practice Address - Country:US
Practice Address - Phone:231-652-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist