Provider Demographics
NPI:1598948705
Name:BILAN, SANDRA K (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:BILAN
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 1:159 HORSEBLOCK RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4361
Mailing Address - Country:US
Mailing Address - Phone:631-880-3828
Mailing Address - Fax:
Practice Address - Street 1:160 N RESEARCH PL
Practice Address - Street 2:T-2102
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4458
Practice Address - Country:US
Practice Address - Phone:631-297-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist