Provider Demographics
NPI:1417424714
Name:SAMUEL, SARAH ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 N VAN AUKEN ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2032
Mailing Address - Country:US
Mailing Address - Phone:630-880-8702
Mailing Address - Fax:
Practice Address - Street 1:199 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2853
Practice Address - Country:US
Practice Address - Phone:520-364-1279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301047183500000X
AZS023197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist