MEDICARE: DESIREE SACINSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051286211	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051286211	OTHER	IL	LICENSE

General Provider Information

NPI Number	:	1427333269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE SACINSKI

Provider Business Mailing Address
First Line	:	12659 S RIDGELAND AVE
Second Line	:	WALGREENS #9347
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12659 S RIDGELAND AVE
Second Line	:	WALGREENS #9347
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1871
Country	:	US
Telephone Number	:	708-385-0218
Fax Number	:	708-385-1045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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Directions to “ DESIREE SACINSKI ” Practice Location

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