Provider Demographics
NPI:1043961444
Name:FERRO, TIMOTHY M (RPH)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:FERRO
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 1:3931 IRISH HILLS DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-6530
Mailing Address - Country:US
Mailing Address - Phone:574-850-6246
Mailing Address - Fax:
Practice Address - Street 1:1400 E IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3452
Practice Address - Country:US
Practice Address - Phone:574-231-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016331A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist