Provider Demographics
NPI:1790085728
Name:ILLIG, NANCY ANNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:ILLIG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4506
Mailing Address - Country:US
Mailing Address - Phone:916-773-4115
Mailing Address - Fax:916-773-4173
Practice Address - Street 1:989 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4506
Practice Address - Country:US
Practice Address - Phone:916-773-4115
Practice Address - Fax:916-773-4173
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist