Provider Demographics
NPI:1922431311
Name:SABISTINA, ///CHONA (BS)
Entity Type:Individual
Prefix:MRS
First Name:///CHONA
Middle Name:
Last Name:SABISTINA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:CHONA
Other - Middle Name:
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:KINGS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:96143-1312
Mailing Address - Country:US
Mailing Address - Phone:775-772-7081
Mailing Address - Fax:
Practice Address - Street 1:8001 LINCOLN AVE STE 800
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3657
Practice Address - Country:US
Practice Address - Phone:775-772-7081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11231183500000X
NM5346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist