Provider Demographics
NPI:1063700896
Name:NERLAND, TINA M (RP)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:M
Last Name:NERLAND
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1078
Mailing Address - Country:US
Mailing Address - Phone:217-483-5505
Mailing Address - Fax:217-483-5529
Practice Address - Street 1:1050 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1078
Practice Address - Country:US
Practice Address - Phone:217-483-5505
Practice Address - Fax:217-483-5529
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist