Provider Demographics
NPI:1760079222
Name:SABINSON, KARRIE
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:
Last Name:SABINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IL
Mailing Address - Zip Code:61087-0626
Mailing Address - Country:US
Mailing Address - Phone:815-745-3700
Mailing Address - Fax:815-745-3663
Practice Address - Street 1:137 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IL
Practice Address - Zip Code:61087-9367
Practice Address - Country:US
Practice Address - Phone:815-745-3700
Practice Address - Fax:815-745-3663
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051288382OtherIL PHARMACIST LICENSE