Healthcare Provider Details

I. General information

NPI: 1891071031
Provider Name (Legal Business Name): SARAH A AMBROSE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOWER MAIN ST
FREEPORT ME
04032-1030
US

IV. Provider business mailing address

200 LOWER MAIN ST
FREEPORT ME
04032-1030
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-0205
  • Fax: 207-865-0567
Mailing address:
  • Phone: 207-865-0205
  • Fax: 207-865-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5612
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: