Provider Demographics
NPI:1356798805
Name:TOLLERUD, HELEN MARIE (RPH)
Entity type:Individual
Prefix:MS
First Name:HELEN
Middle Name:MARIE
Last Name:TOLLERUD
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 1:965 TALLGRASS DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-5073
Mailing Address - Country:US
Mailing Address - Phone:630-830-9594
Mailing Address - Fax:
Practice Address - Street 1:125 E STEARNS RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-6534
Practice Address - Country:US
Practice Address - Phone:630-540-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist