Provider Demographics
NPI:1316229321
Name:BARONE, SAM (RPH)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:BARONE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21615 N HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2347
Mailing Address - Country:US
Mailing Address - Phone:847-381-6566
Mailing Address - Fax:847-381-6698
Practice Address - Street 1:305 S EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4626
Practice Address - Country:US
Practice Address - Phone:815-338-7880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-0337481835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist