Healthcare Provider Details

I. General information

NPI: 1235852229
Provider Name (Legal Business Name): SARAH ANNE MIHULKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 301
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

202 N MILL ST APT 8
COLFAX WA
99111-1856
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-4608
  • Fax: 509-332-3341
Mailing address:
  • Phone: 541-337-5223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP10312
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61307177
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: