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General NPI Number Information
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NPI Number | 1912264995
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Entity Type | Individual
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Provider Name | SARA MAHAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 805 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3300
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Country | US
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Telephone | 630-495-2333
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Fax | 630-495-2355
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Provider Business Mailing Address
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Address Line | 25627 207TH AVE SE
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City | COVINGTON
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State | WA
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Zip | 98042-6200
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Country | US
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Telephone | 630-664-2245
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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 | 67026
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.294819
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60478099
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License Number State | WA
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