Healthcare Provider Details

I. General information

NPI: 1912814369
Provider Name (Legal Business Name): TIMOTHY AUBRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 GRANT ST
HARVARD IL
60033-1821
US

IV. Provider business mailing address

901 GRANT ST
HARVARD IL
60033-1821
US

V. Phone/Fax

Practice location:
  • Phone: 815-943-8646
  • Fax: 815-943-8280
Mailing address:
  • Phone: 815-943-8646
  • Fax: 815-943-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.039375
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: