MEDICARE: TIMOTHY JAMES SASSIN PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302036383	MI

General Provider Information

NPI Number	:	1528521036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY JAMES SASSIN PHARM.D

Provider Business Mailing Address
First Line	:	56109 VILLAGE CENTER CIR
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-8368
Country	:	US
Telephone Number	:	269-668-6801
Fax Number	:	269-668-6802

Provider Business Practice Location Address
First Line	:	56109 VILLAGE CENTER CIR
Second Line	:
City	:	MATTAWAN
State	:	MI
Zip	:	49071-8368
Country	:	US
Telephone Number	:	269-668-6801
Fax Number	:	269-668-6802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/11/2019

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