=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043782386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH B AUDI PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2018
-----------------------------------------------------
Last Update Date | 12/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3720 NEW GERMANY RD
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-1862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-9390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 W SAMPLE ST
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-291-0691
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP453141
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------