Healthcare Provider Details

I. General information

NPI: 1376655852
Provider Name (Legal Business Name): SARAH E MCBANE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MC 0719 9500 GILMAN DRIVE
LA JOLLA CA
92093-0001
US

IV. Provider business mailing address

10698 PASSERINE WAY
SAN DIEGO CA
92121-4200
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-3391
  • Fax:
Mailing address:
  • Phone: 858-822-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16843
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number63712
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number63712
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number63712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: