MEDICARE: MR. TIMOTHY MARTIN STIFF RPH.

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	5302023340	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215927793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY MARTIN STIFF RPH.

Provider Business Mailing Address
First Line	:	198 EAGLE CT
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48162-8849
Country	:	US
Telephone Number	:	734-243-5558
Fax Number	:	734-529-5744

Provider Business Practice Location Address
First Line	:	115 RILEY ST
Second Line	:
City	:	DUNDEE
State	:	MI
Zip	:	48131-1025
Country	:	US
Telephone Number	:	734-529-2246
Fax Number	:	734-529-5744

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/09/2007

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