Provider Demographics
NPI:1073638193
Name:DURRANT, TINA MARIE (PHARM D)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:DURRANT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12757 W MAJOR AVE
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60099-9592
Mailing Address - Country:US
Mailing Address - Phone:847-912-3858
Mailing Address - Fax:847-856-8704
Practice Address - Street 1:6655 GRAND AVE
Practice Address - Street 2:DOMINICK'S PHARMACY #1151
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-856-8701
Practice Address - Fax:847-856-8704
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist