Provider Demographics
NPI:1023399953
Name:SAWA, SUSAN GRACE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GRACE
Last Name:SAWA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N ELMHURST RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1509
Mailing Address - Country:US
Mailing Address - Phone:847-398-4673
Mailing Address - Fax:
Practice Address - Street 1:1 N ELMHURST RD
Practice Address - Street 2:
Practice Address - City:PROSPECT HTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1509
Practice Address - Country:US
Practice Address - Phone:847-398-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-035104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist