Provider Demographics
NPI:1881971976
Name:BOYD, TIMOTHY R
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:R
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1685
Mailing Address - Country:US
Mailing Address - Phone:708-344-9885
Mailing Address - Fax:708-344-8450
Practice Address - Street 1:100 LAKE ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1685
Practice Address - Country:US
Practice Address - Phone:708-344-9885
Practice Address - Fax:708-344-8450
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-032615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist