Provider Demographics
NPI:1255810974
Name:TIMMERMANN & ASSOCIATES INC
Entity type:Organization
Organization Name:TIMMERMANN & ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-526-8040
Mailing Address - Street 1:117 CLINTONIAN PLZ
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1501
Mailing Address - Country:US
Mailing Address - Phone:618-526-8040
Mailing Address - Fax:
Practice Address - Street 1:117 CLINTONIAN PLZ
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1501
Practice Address - Country:US
Practice Address - Phone:618-526-8040
Practice Address - Fax:618-526-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.0141543336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy