Provider Demographics
NPI:1205168481
Name:ROZENE, TAL M (RPH)
Entity type:Individual
Prefix:MR
First Name:TAL
Middle Name:M
Last Name:ROZENE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-5206
Mailing Address - Country:US
Mailing Address - Phone:217-347-7927
Mailing Address - Fax:847-747-1564
Practice Address - Street 1:1006 N KELLER DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1743
Practice Address - Country:US
Practice Address - Phone:217-347-2560
Practice Address - Fax:217-347-3877
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.040198183500000X
IA18372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist