Basic Information
Provider Information
NPI: 1346885142
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEMAN
FirstName: SARAH
MiddleName: LOHR
NamePrefix:  
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 860
Address2:  
City: WHITERIVER
State: AZ
PostalCode: 859410860
CountryCode: US
TelephoneNumber: 9283383502
FaxNumber:  
Practice Location
Address1: PHARMACY
Address2: WHITERIVER INDIAN HOSPITAL
City: WHITERIVER
State: AZ
PostalCode: 859410860
CountryCode: US
TelephoneNumber: 9283383502
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/15/2019
LastUpdateDate: 11/15/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X51385CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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