Provider Demographics
NPI:1578832937
Name:MAHERAS, SANDI (PHARM-D)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:MAHERAS
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:BARBAHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM-D
Mailing Address - Street 1:1703 SPYGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-3103
Mailing Address - Country:US
Mailing Address - Phone:708-601-6522
Mailing Address - Fax:
Practice Address - Street 1:1703 SPYGLASS CIR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-601-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023081A183500000X
IL051.292566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist