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General NPI Number Information
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NPI Number | 1508466616
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Entity Type | Individual
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Provider Name | JOHN ALEXANDER SANGUEZA
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Gender | Male
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 17625 TORRENCE AVE
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City | LANSING
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State | IL
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Zip | 60438-4839
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Country | US
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Telephone | 708-474-9237
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Fax |
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Provider Business Mailing Address
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Address Line | 9825 NEW DEVON ST
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City | MUNSTER
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State | IN
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Zip | 46321-9146
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.287518
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License Number State | IL
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