Provider Demographics
NPI:1881402279
Name:FAY, TIMOTHY FLOYD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:FLOYD
Last Name:FAY
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 1:709 N ROWE ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1455
Mailing Address - Country:US
Mailing Address - Phone:231-907-8999
Mailing Address - Fax:
Practice Address - Street 1:3100 CHANNEL DR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7837
Practice Address - Country:US
Practice Address - Phone:907-463-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist