Provider Demographics
NPI:1851994800
Name:TINGLEFF, MICHELE MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:TINGLEFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:MARIE
Other - Last Name:TINGLEFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:6216 S HARKERS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61607-9605
Mailing Address - Country:US
Mailing Address - Phone:309-208-4709
Mailing Address - Fax:309-389-5585
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2549
Practice Address - Country:US
Practice Address - Phone:309-694-1496
Practice Address - Fax:309-694-2097
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist