Provider Demographics
NPI:1528341146
Name:SANARIZ, RONALD A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:SANARIZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 W DIVERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1056
Mailing Address - Country:US
Mailing Address - Phone:773-283-8150
Mailing Address - Fax:773-283-3174
Practice Address - Street 1:3934 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1056
Practice Address - Country:US
Practice Address - Phone:773-283-8150
Practice Address - Fax:773-283-3174
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361924025068Medicaid