Provider Demographics
NPI:1104549062
Name:WALSH, TIMOTHY (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WALSH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W ILLINOIS ST UNIT 1704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-4642
Mailing Address - Country:US
Mailing Address - Phone:414-405-9651
Mailing Address - Fax:
Practice Address - Street 1:678 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3717
Practice Address - Country:US
Practice Address - Phone:312-255-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist