Provider Demographics
NPI:1376838631
Name:HARPER, SAMUEL RAYMOND (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RAYMOND
Last Name:HARPER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5071 CAL SAG RD
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60445-1458
Mailing Address - Country:US
Mailing Address - Phone:708-385-3199
Mailing Address - Fax:708-385-3199
Practice Address - Street 1:5071 CAL SAG RD
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-1458
Practice Address - Country:US
Practice Address - Phone:708-385-3199
Practice Address - Fax:708-385-3199
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist