Provider Demographics
NPI:1952357311
Name:SMITH, TIMOTHY D (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 MCDIARMID LN
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-2060
Mailing Address - Country:US
Mailing Address - Phone:517-281-6527
Mailing Address - Fax:517-627-1984
Practice Address - Street 1:928 MCDIARMID LN
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2060
Practice Address - Country:US
Practice Address - Phone:517-281-6527
Practice Address - Fax:517-627-1984
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist