Healthcare Provider Details

I. General information

NPI: 1245511641
Provider Name (Legal Business Name): SARAH KIM CRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S HARPER AVE APT 903
CHICAGO IL
60637-2936
US

IV. Provider business mailing address

6040 S HARPER AVE APT 903
CHICAGO IL
60637-2936
US

V. Phone/Fax

Practice location:
  • Phone: 217-778-4377
  • Fax:
Mailing address:
  • Phone: 217-778-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049.204394
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: