Provider Demographics
NPI:1578169132
Name:OYIBO, SANDRA E (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:OYIBO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-4613
Mailing Address - Country:US
Mailing Address - Phone:312-428-0312
Mailing Address - Fax:
Practice Address - Street 1:3200 FLOSSMOOR RD
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4484
Practice Address - Country:US
Practice Address - Phone:708-798-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051303408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051303408OtherIDFPR