Provider Demographics
NPI:1083476238
Name:SANDERSON, SARAH BETH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 JOPLIN AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:IA
Mailing Address - Zip Code:50622-1037
Mailing Address - Country:US
Mailing Address - Phone:319-269-1573
Mailing Address - Fax:
Practice Address - Street 1:700 S STATE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:IA
Practice Address - Zip Code:50622-7000
Practice Address - Country:US
Practice Address - Phone:319-984-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist