Provider Demographics
NPI:1366722019
Name:TAMAS, TATIANA B (RPH)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:B
Last Name:TAMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2556
Mailing Address - Country:US
Mailing Address - Phone:773-764-8961
Mailing Address - Fax:773-764-5736
Practice Address - Street 1:6125 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2556
Practice Address - Country:US
Practice Address - Phone:773-764-8961
Practice Address - Fax:773-764-5736
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist