Provider Demographics
NPI:1447607924
Name:TIERI, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TIERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17705 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2009
Mailing Address - Country:US
Mailing Address - Phone:708-957-1750
Mailing Address - Fax:
Practice Address - Street 1:17705 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2009
Practice Address - Country:US
Practice Address - Phone:708-957-1750
Practice Address - Fax:708-922-9637
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist