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General NPI Number Information
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NPI Number | 1174251730
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Entity Type | Individual
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Provider Name | CARLA SUE TIELL
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Gender | Female
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 722-740 SOUTH MAIN ST
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City | BOWLING GREEN
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State | OH
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Zip | 43402
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Country | US
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Telephone | 419-354-3911
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Fax |
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Provider Business Mailing Address
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Address Line | 13235 SUMNER ST
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City | WESTON
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State | OH
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Zip | 43569-9647
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Country | US
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Telephone | 419-601-8964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State |
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