Provider Demographics
NPI:1912264995
Name:MAHAN, SARA (PHARMD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MAHAN
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 1:25627 207TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6200
Mailing Address - Country:US
Mailing Address - Phone:630-664-2245
Mailing Address - Fax:
Practice Address - Street 1:805 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3300
Practice Address - Country:US
Practice Address - Phone:630-495-2333
Practice Address - Fax:630-495-2355
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67026183500000X
IL051.294819183500000X
WAPH60478099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist