Provider Demographics
NPI:1295330892
Name:ABDULRASOUL, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ABDULRASOUL
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 1:7923 W 157TH ST APT 1S
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5810
Mailing Address - Country:US
Mailing Address - Phone:708-949-0825
Mailing Address - Fax:
Practice Address - Street 1:3400 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1703
Practice Address - Country:US
Practice Address - Phone:708-748-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist