Provider Demographics
NPI:1649169400
Name:SZCZEPANIAK, TIMOTHY J
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:SZCZEPANIAK
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 1:1780 WALL ST
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-5790
Mailing Address - Country:US
Mailing Address - Phone:847-220-2118
Mailing Address - Fax:
Practice Address - Street 1:5545 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3508
Practice Address - Country:US
Practice Address - Phone:847-220-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist