Provider Demographics
NPI:1619249091
Name:PRICE, TANYA MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MONIQUE
Last Name:PRICE
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 1:4822 CATON FARM RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8262
Mailing Address - Country:US
Mailing Address - Phone:815-439-5882
Mailing Address - Fax:
Practice Address - Street 1:4822 CATON FARM RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8262
Practice Address - Country:US
Practice Address - Phone:815-439-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.286613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist