Provider Demographics
NPI:1932816725
Name:CHARD, SYDNIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYDNIE
Middle Name:
Last Name:CHARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 MASON ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1644
Mailing Address - Country:US
Mailing Address - Phone:618-927-0383
Mailing Address - Fax:
Practice Address - Street 1:215 E GRANTWAY ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-1923
Practice Address - Country:US
Practice Address - Phone:618-542-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist