Timothy Etienne, RPH
Individual provider Active NPI Pharmacist · Harrisburg, IL
NPI 1225628449 · NPPES record last updated Jan 21, 2021
Key facts
- NPI
- 1225628449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051039829 (IL)
- Practice address
- 304 S Commercial St
Harrisburg, IL 62946-2108 - Phone
- (618) 252-5349
- Fax
- (618) 252-1395
- NPI assigned
- Jan 21, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051039829 | IL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hardin County Pharmacy LLC | Current | Accepting new patients | |
| Hardin County Pharmacy LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051039829 | IL | Yes |
Addresses
Primary practice location
304 S Commercial St
Harrisburg, IL 62946-2108
Mailing address
304 S Commercial St
Harrisburg, IL 62946-2108
Phone (618) 252-5349
Other providers in Harrisburg, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.