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General NPI Number Information
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NPI Number | 1952528887
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Entity Type | Individual
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Provider Name | TINA KOLOVOS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1451 PETERSON RD
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1001
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Country | US
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Telephone | 847-573-8067
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Fax | 847-573-8746
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Provider Business Mailing Address
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Address Line | 8815 W GOLF RD UNIT 10J
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City | NILES
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State | IL
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Zip | 60714-5710
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Country | US
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Telephone | 847-375-0369
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Fax | 847-657-1870
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 51286794
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License Number State | IL
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