Healthcare Provider Details

I. General information

NPI: 1740602465
Provider Name (Legal Business Name): SARAH GAO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-1523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6462
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: