Provider Demographics
NPI:1003134743
Name:SPILLER, TANYA ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANNE
Last Name:SPILLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CASE HILL CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3533
Mailing Address - Country:US
Mailing Address - Phone:860-290-8833
Mailing Address - Fax:
Practice Address - Street 1:25 CASE HILL CIR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3533
Practice Address - Country:US
Practice Address - Phone:860-290-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist