Provider Demographics
NPI:1336421106
Name:LAVERY, TIMOTHY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:LAVERY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 W TOUHY AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5324
Mailing Address - Country:US
Mailing Address - Phone:847-647-0989
Mailing Address - Fax:
Practice Address - Street 1:4010 W. LAWRENCE AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-286-0309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287943183500000X
IN26024058A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist