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NPI Code Detail

MEDICARE: SARA ROBERTSON MCCULLOUGH

MEDICARE: SARA ROBERTSON MCCULLOUGH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist21121AL

General Provider Information

NPI Number : 1548817265
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA ROBERTSON MCCULLOUGH
Provider Business Mailing Address
First Line : 14932 DREW DR
Second Line :
City : MOUNDVILLE
State : AL
Zip : 35474-6154
Country : US
Telephone Number : 205-523-2575
Fax Number :
Provider Business Practice Location Address
First Line : 1101 SOUTHVIEW LN
Second Line :
City : TUSCALOOSA
State : AL
Zip : 35405-6389
Country : US
Telephone Number : 205-247-7715
Fax Number : 205-247-7720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2019
Last Update Date : 08/19/2019

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Directions to “ SARA ROBERTSON MCCULLOUGH ” Practice Location

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