Provider Demographics
NPI:1952528887
Name:KOLOVOS, TINA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:KOLOVOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 W GOLF RD
Mailing Address - Street 2:UNIT 10J
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5710
Mailing Address - Country:US
Mailing Address - Phone:847-375-0369
Mailing Address - Fax:847-657-1870
Practice Address - Street 1:1451 PETERSON RD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1001
Practice Address - Country:US
Practice Address - Phone:847-573-8067
Practice Address - Fax:847-573-8746
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51286794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist