Provider Demographics
NPI:1215531082
Name:PROKOP, SARAH JEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JEAN
Last Name:PROKOP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DR
Mailing Address - Street 1:800 BROADVIEW VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-4887
Mailing Address - Country:US
Mailing Address - Phone:708-731-5555
Mailing Address - Fax:
Practice Address - Street 1:800 BROADVIEW VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:BROADVIEW
Practice Address - State:IL
Practice Address - Zip Code:60155-4887
Practice Address - Country:US
Practice Address - Phone:708-731-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist