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General NPI Number Information
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NPI Number | 1336421106
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Entity Type | Individual
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Provider Name | TIMOTHY LAVERY PHARM D
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Gender | Male
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 4010 W. LAWRENCE AVE.
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City | CHICAGO
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State | IL
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Zip | 60630
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Country | US
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Telephone | 773-286-0309
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Fax |
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Provider Business Mailing Address
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Address Line | 7071 W TOUHY AVE APT 605
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City | NILES
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State | IL
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Zip | 60714-5324
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Country | US
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Telephone | 847-647-0989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051287943
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26024058A
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License Number State | IN
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