Provider Demographics
NPI:1861442667
Name:ROBERTS, SARA B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:B
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:33985 TB RUYLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDORA
Mailing Address - State:IL
Mailing Address - Zip Code:62063-3017
Mailing Address - Country:US
Mailing Address - Phone:618-729-1270
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6722
Practice Address - Country:US
Practice Address - Phone:618-463-7833
Practice Address - Fax:618-463-7722
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003020525183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist