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NPI Code Detail

MEDICARE: POONAM TANNA PHARMD

MEDICARE: POONAM TANNA PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051295113IL

General Provider Information

NPI Number : 1699370544
Entity Type Code : Individual
Provider Name (Legal Business Name) : POONAM TANNA PHARMD
Provider Business Mailing Address
First Line : 701 S WELLS ST APT 2501
Second Line :
City : CHICAGO
State : IL
Zip : 60607-4643
Country : US
Telephone Number : 708-205-6048
Fax Number :
Provider Business Practice Location Address
First Line : 205 N COLUMBUS DR
Second Line :
City : CHICAGO
State : IL
Zip : 60601-7801
Country : US
Telephone Number : 312-861-0315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2020
Last Update Date : 11/30/2020

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Directions to “ POONAM TANNA PHARMD” Practice Location

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