Healthcare Provider Details

I. General information

NPI: 1841401601
Provider Name (Legal Business Name): SARA JEANNE PUTERBAUGH R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 W ALEXIS RD
TOLEDO OH
43612-4303
US

IV. Provider business mailing address

17518 IDA CENTER RD
PETERSBURG MI
49270-9749
US

V. Phone/Fax

Practice location:
  • Phone: 419-269-6909
  • Fax: 419-269-6911
Mailing address:
  • Phone: 734-279-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-17849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: