1568583375 NPI number — SARAH ANN HARMON BS, PHARMD, RPH

Table of content: SARAH ANN HARMON BS, PHARMD, RPH (NPI 1568583375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568583375 NPI number — SARAH ANN HARMON BS, PHARMD, RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMON
Provider First Name:
SARAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, PHARMD, RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NALL
Provider Other First Name:
SARAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS, PHARMD, RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568583375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 W CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61530-1111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-467-3161
Provider Business Mailing Address Fax Number:
309-467-3497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 W CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61530-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-467-3161
Provider Business Practice Location Address Fax Number:
309-467-3497
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  051290947 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051290947 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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