Provider Demographics
NPI:1013215573
Name:SHOBERG, SARAH ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:SHOBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 40TH AVE W
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4612
Mailing Address - Country:US
Mailing Address - Phone:425-670-9987
Mailing Address - Fax:425-744-7233
Practice Address - Street 1:101 SUN AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4373
Practice Address - Country:US
Practice Address - Phone:425-670-9987
Practice Address - Fax:425-744-7233
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00071269183500000X
ORRPH-0010854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist