Healthcare Provider Details

I. General information

NPI: 1134565658
Provider Name (Legal Business Name): SARAH SIDLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 114TH AVE N
CHAMPLIN MN
55316-3869
US

IV. Provider business mailing address

5643 GREEN CIRCLE DR APT 111
MINNETONKA MN
55343-9652
US

V. Phone/Fax

Practice location:
  • Phone: 763-422-8700
  • Fax:
Mailing address:
  • Phone: 260-243-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26021480A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number121192
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: