Provider Demographics
NPI:1699059782
Name:ALLISON, TANDREA N (RPH)
Entity type:Individual
Prefix:MRS
First Name:TANDREA
Middle Name:N
Last Name:ALLISON
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 1:16059 GARNET LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-6454
Mailing Address - Country:US
Mailing Address - Phone:309-828-3485
Mailing Address - Fax:
Practice Address - Street 1:505 W RAAB RD
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1007
Practice Address - Country:US
Practice Address - Phone:309-454-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-287575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist