Healthcare Provider Details

I. General information

NPI: 1528544798
Provider Name (Legal Business Name): SARAH A ABRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 N RICHMOND ST
APPLETON WI
54913-9631
US

IV. Provider business mailing address

3133 TRI PARK CT APT 2
APPLETON WI
54914-6425
US

V. Phone/Fax

Practice location:
  • Phone: 920-350-6210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number19433-10
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: