Healthcare Provider Details

I. General information

NPI: 1407487176
Provider Name (Legal Business Name): TIMOTHY HAINES PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 DEXTER ST
MILAN MI
48160-1168
US

IV. Provider business mailing address

1445 BELMONT ST
DEARBORN MI
48128-1419
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-3000
  • Fax:
Mailing address:
  • Phone: 574-238-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26021811A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302046353
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: