=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902304645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA BRAME RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2018
-----------------------------------------------------
Last Update Date | 09/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 FARM LIFE AVE
-----------------------------------------------------
City | VANCEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28586-7797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-244-1086
-----------------------------------------------------
Fax | 252-244-2264
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 421 FARM LIFE AVE
-----------------------------------------------------
City | VANCEBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28586-7797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-244-1086
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | 10931
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------