Provider Demographics
NPI:1053588475
Name:BLOOM, TIMOTHY DOUGLAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DOUGLAS
Last Name:BLOOM
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 1:38920 UPLAND CT
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:FRANKFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19945-4709
Mailing Address - Country:US
Mailing Address - Phone:302-539-3334
Mailing Address - Fax:
Practice Address - Street 1:219 ATLANTIC AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6701
Practice Address - Country:US
Practice Address - Phone:302-539-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist