Provider Demographics
NPI:1215927793
Name:STIFF, TIMOTHY MARTIN (RPH)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARTIN
Last Name:STIFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-8849
Mailing Address - Country:US
Mailing Address - Phone:734-243-5558
Mailing Address - Fax:734-529-5744
Practice Address - Street 1:115 RILEY ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-1025
Practice Address - Country:US
Practice Address - Phone:734-529-2246
Practice Address - Fax:734-529-5744
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2329349Medicaid