Provider Demographics
NPI:1386927630
Name:LITMER, TIM M (RPH)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:M
Last Name:LITMER
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 1:98 LAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1882
Mailing Address - Country:US
Mailing Address - Phone:513-379-1979
Mailing Address - Fax:
Practice Address - Street 1:4090 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:OH
Practice Address - Zip Code:45236-2324
Practice Address - Country:US
Practice Address - Phone:513-891-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0486102Medicaid