Provider Demographics
NPI:1477835114
Name:HENSLEY, SARA ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:KOEBELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5291 CROSS ROAD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881
Mailing Address - Country:US
Mailing Address - Phone:618-292-9639
Mailing Address - Fax:618-242-1293
Practice Address - Street 1:3001 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2361
Practice Address - Country:US
Practice Address - Phone:618-242-1442
Practice Address - Fax:618-242-1293
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist