Provider Demographics
NPI:1194569863
Name:OULD AMMAR, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:OULD AMMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 W 82ND PL
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2716
Mailing Address - Country:US
Mailing Address - Phone:708-470-0196
Mailing Address - Fax:
Practice Address - Street 1:2 N STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3203
Practice Address - Country:US
Practice Address - Phone:312-332-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.306325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist