Healthcare Provider Details

I. General information

NPI: 1447336722
Provider Name (Legal Business Name): SAM RASTY PHARM.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 BELMAR LN
BUFFALO GROVE IL
60089-1350
US

IV. Provider business mailing address

870 BELMAR LN
BUFFALO GROVE IL
60089-1350
US

V. Phone/Fax

Practice location:
  • Phone: 847-465-0127
  • Fax: 847-520-9937
Mailing address:
  • Phone: 847-465-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051288543
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: