Provider Demographics
NPI:1962965517
Name:TELANDER, TINA JO (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:JO
Last Name:TELANDER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2757
Mailing Address - Country:US
Mailing Address - Phone:319-545-6412
Mailing Address - Fax:319-545-6415
Practice Address - Street 1:2801 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2757
Practice Address - Country:US
Practice Address - Phone:319-545-6412
Practice Address - Fax:319-545-6415
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist