Healthcare Provider Details

I. General information

NPI: 1982972170
Provider Name (Legal Business Name): JAMI TARASIEVICH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 05/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 W DEMPSTER ST
NILES IL
60714-5108
US

IV. Provider business mailing address

8730 W DEMPSTER ST
NILES IL
60714-5108
US

V. Phone/Fax

Practice location:
  • Phone: 847-296-8847
  • Fax: 847-291-1658
Mailing address:
  • Phone: 847-296-8847
  • Fax: 847-291-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.294138
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: