Healthcare Provider Details

I. General information

NPI: 1649576802
Provider Name (Legal Business Name): SARAH L GERBER HUBBARD PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH L GERBER PHARM D

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PARKER ST
BOSCOBEL WI
53805-1642
US

IV. Provider business mailing address

205 PARKER ST
BOSCOBEL WI
53805-1642
US

V. Phone/Fax

Practice location:
  • Phone: 608-375-4112
  • Fax:
Mailing address:
  • Phone: 608-375-4112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16079-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: