Provider Demographics
NPI:1629363916
Name:TYLKA, SANDRA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:TYLKA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 191ST ST
Mailing Address - Street 2:T2035
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-9361
Mailing Address - Country:US
Mailing Address - Phone:815-806-3211
Mailing Address - Fax:815-806-3221
Practice Address - Street 1:7300 191ST ST
Practice Address - Street 2:T2035
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9361
Practice Address - Country:US
Practice Address - Phone:815-806-3211
Practice Address - Fax:815-806-3221
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051287787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist