Basic Information
| Provider Information | |||||||||
| NPI: | 1013215573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHOBERG | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19401 40TH AVE W | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | LYNNWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980364612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256709987 | ||||||||
| FaxNumber: | 4257447233 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 SUN AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256709987 | ||||||||
| FaxNumber: | 4257447233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2011 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH00071269 | WA | Y | Pharmacy Service Providers | Pharmacist | 183500000X | RPH-0010854 | OR | N | Pharmacy Service Providers | Pharmacist |
No ID Information.