Provider Demographics
NPI:1659585693
Name:HARSTAD, NANCY L (RPH)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:HARSTAD
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 1:735 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7135
Mailing Address - Country:US
Mailing Address - Phone:847-963-9302
Mailing Address - Fax:847-368-1808
Practice Address - Street 1:122 N VAIL AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1432
Practice Address - Country:US
Practice Address - Phone:847-368-1795
Practice Address - Fax:847-368-1808
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist