Provider Demographics
NPI:1659612943
Name:SABANI, ISTREF SAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:ISTREF
Middle Name:SAM
Last Name:SABANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-8637
Mailing Address - Country:US
Mailing Address - Phone:815-218-7028
Mailing Address - Fax:
Practice Address - Street 1:796 RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-8637
Practice Address - Country:US
Practice Address - Phone:815-218-7028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist