Provider Demographics
NPI:1528521036
Name:SASSIN, TIMOTHY JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:SASSIN
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 1:56109 VILLAGE CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8368
Mailing Address - Country:US
Mailing Address - Phone:269-668-6801
Mailing Address - Fax:269-668-6802
Practice Address - Street 1:56109 VILLAGE CENTER CIR
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-8368
Practice Address - Country:US
Practice Address - Phone:269-668-6801
Practice Address - Fax:269-668-6802
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist