Provider Demographics
NPI:1447336722
Name:RASTY, SAM (PHARMD, MPH)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:RASTY
Suffix:
Gender:M
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 BELMAR LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1350
Mailing Address - Country:US
Mailing Address - Phone:847-465-0127
Mailing Address - Fax:
Practice Address - Street 1:870 BELMAR LN
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1350
Practice Address - Country:US
Practice Address - Phone:847-465-0127
Practice Address - Fax:847-520-9937
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512885431835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy