Provider Demographics
NPI:1427137827
Name:PURI, SANDRA CUELLAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:CUELLAR
Last Name:PURI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:CUELLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:833 W 15TH PL UNIT 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1845
Mailing Address - Country:US
Mailing Address - Phone:630-781-1570
Mailing Address - Fax:312-996-0379
Practice Address - Street 1:833 S WOOD ST # 886
Practice Address - Street 2:SUITE 164
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7229
Practice Address - Country:US
Practice Address - Phone:312-996-0870
Practice Address - Fax:312-996-0379
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology