Provider Demographics
NPI:1255324943
Name:BIERLY, TANIA NICOLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:NICOLE
Last Name:BIERLY
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 1:470 COLUMBINE LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1753
Mailing Address - Country:US
Mailing Address - Phone:440-225-0707
Mailing Address - Fax:
Practice Address - Street 1:221 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1524
Practice Address - Country:US
Practice Address - Phone:630-549-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301117183500000X
OH03221563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist