Provider Demographics
NPI:1699061036
Name:TANKER, NATHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:TANKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9833 N ALPINE RD
Mailing Address - Street 2:T-1799
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1681
Mailing Address - Country:US
Mailing Address - Phone:815-639-3301
Mailing Address - Fax:815-639-3301
Practice Address - Street 1:9833 N ALPINE RD
Practice Address - Street 2:T-1799
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1681
Practice Address - Country:US
Practice Address - Phone:815-639-3301
Practice Address - Fax:815-639-3301
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.293239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist