Provider Demographics
NPI:1104107283
Name:CRUM, TIMOTHY D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:CRUM
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 1:5264 LEE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1232
Mailing Address - Country:US
Mailing Address - Phone:216-663-5103
Mailing Address - Fax:
Practice Address - Street 1:5264 LEE RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1232
Practice Address - Country:US
Practice Address - Phone:216-663-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist