Provider Demographics
NPI:1013389519
Name:WIDNER, SARAH (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:WIDNER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 VIA NIEVE UNIT 56
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3145
Mailing Address - Country:US
Mailing Address - Phone:760-500-3806
Mailing Address - Fax:
Practice Address - Street 1:883 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5237
Practice Address - Country:US
Practice Address - Phone:760-630-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist