MEDICARE: MRS. RENAE M SANCHEZ R.PH.

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	IL051041101	IL

General Provider Information

NPI Number	:	1629352604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENAE M SANCHEZ R.PH.

Provider Business Mailing Address
First Line	:	3216 EAST CLEARLAKE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702
Country	:	US
Telephone Number	:	217-544-7948
Fax Number	:	217-544-0793

Provider Business Practice Location Address
First Line	:	3216 EAST CLEARLAKE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702
Country	:	US
Telephone Number	:	217-544-7948
Fax Number	:	217-544-0793

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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