Healthcare Provider Details

I. General information

NPI: 1710585575
Provider Name (Legal Business Name): TARA ARKAN CISNEROS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA ARKAN JEBRAEL

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N GREENWOOD AVE
NILES IL
60714-1408
US

IV. Provider business mailing address

8034 W LYONS ST
NILES IL
60714-1332
US

V. Phone/Fax

Practice location:
  • Phone: 847-298-3050
  • Fax:
Mailing address:
  • Phone: 847-293-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303450
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: