Healthcare Provider Details

I. General information

NPI: 1730049131
Provider Name (Legal Business Name): TATE ELLER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 TOWANDA AVE STE 11
BLOOMINGTON IL
61701-7415
US

IV. Provider business mailing address

1210 TOWANDA AVE STE 11
BLOOMINGTON IL
61701-7415
US

V. Phone/Fax

Practice location:
  • Phone: 309-828-6767
  • Fax: 309-828-6970
Mailing address:
  • Phone: 309-828-6767
  • Fax: 309-828-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.306786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: