Active NPI
Timothy John Sullens
- Pharmacist
- Olney, IL
National Provider Identifier
1407456981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 051038950
- Practice address
- 1001 N West St
Olney, IL 62450-3774 - Phone
- (618) 292-3464
- Fax
- (618) 392-3260
- NPI assigned
- Oct 26, 2020
- Last updated
- Oct 26, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051038950 | IL | Primary |
Addresses
Primary practice location
1001 N West St
Olney, IL 62450-3774
Mailing address
1001 N West St
Olney, IL 62450-3774
Phone (618) 292-3464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051038950 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603670400000",
"number": "1407456981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 N WEST ST",
"city": "OLNEY",
"state": "IL",
"postal_code": "624503774",
"telephone_number": "618-292-3464",
"fax_number": "618-392-3260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 N WEST ST",
"city": "OLNEY",
"state": "IL",
"postal_code": "624503774",
"telephone_number": "618-292-3464",
"fax_number": "618-392-3260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLENS",
"first_name": "TIMOTHY",
"middle_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-26",
"last_updated": "2020-10-26",
"certification_date": "2020-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051038950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olney, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.