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NPI Code Detail

MEDICARE: TANJA WIERSUM PHARMD

MEDICARE: TANJA WIERSUM PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.289153IL

General Provider Information

NPI Number : 1861093361
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANJA WIERSUM PHARMD
Provider Business Mailing Address
First Line : 3801 RUNNING BROOK FARM BLVD
Second Line :
City : JOHNSBURG
State : IL
Zip : 60051-5425
Country : US
Telephone Number : 815-344-8137
Fax Number :
Provider Business Practice Location Address
First Line : 3801 RUNNING BROOK FARM BLVD
Second Line :
City : JOHNSBURG
State : IL
Zip : 60051-5425
Country : US
Telephone Number : 815-344-8137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2020
Last Update Date : 11/03/2020

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Directions to “ TANJA WIERSUM PHARMD” Practice Location

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