Individual provider Active NPI

Irene Diana Sebeh, RPH

  • Pharmacist
  • Waukegan, IL
National Provider Identifier
1720461288
Registry record updated Jul 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
051288634 Issued in IL
Practice address
3050 N Lewis Ave
Waukegan, IL 60087-2231
Phone
(847) 599-9079
NPI assigned
Jul 2, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 051288634 IL Primary
Pharmacist 183500000X 15376040 WI

Addresses

Primary practice location

3050 N Lewis Ave
Waukegan, IL 60087-2231

Mailing address

13196 W Wakefield Dr
None
Beach Park, IL 60083-3014
Phone (847) 249-3155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
051288634ILMDPharmacist
15376040WIMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435795200000",
    "number": "1720461288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13196 W WAKEFIELD DR",
            "address_2": "NONE",
            "city": "BEACH PARK",
            "state": "IL",
            "postal_code": "600833014",
            "telephone_number": "847-249-3155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 N LEWIS AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600872231",
            "telephone_number": "847-599-9079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEBEH",
        "first_name": "IRENE",
        "middle_name": "DIANA",
        "name_prefix": "Mrs.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2015-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051288634",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "15376040",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.