Provider Demographics
NPI:1356563720
Name:NECASEK, TINA (RPH)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NECASEK
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 1:10 E ONTARIO ST
Mailing Address - Street 2:APARTMENT 1704
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4763
Mailing Address - Country:US
Mailing Address - Phone:614-361-9545
Mailing Address - Fax:
Practice Address - Street 1:233 N MICHIGAN AVE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5519
Practice Address - Country:US
Practice Address - Phone:312-424-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325461183500000X
IL51290990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist