Provider Demographics
NPI:1407458722
Name:VAN RHEEDEN, SALLY ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANNE
Last Name:VAN RHEEDEN
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 1:2300 W WHITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6423
Mailing Address - Country:US
Mailing Address - Phone:217-698-5938
Mailing Address - Fax:
Practice Address - Street 1:2300 W WHITE OAKS DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6423
Practice Address - Country:US
Practice Address - Phone:217-698-5938
Practice Address - Fax:217-698-6427
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051038699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist