Provider Demographics
NPI:1144452483
Name:WHITTENBURG, SARAH BETH RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH RAE
Last Name:WHITTENBURG
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 1:2452 SOUTHMONT DR
Mailing Address - Street 2:APT #206
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-7085
Mailing Address - Country:US
Mailing Address - Phone:423-329-0286
Mailing Address - Fax:
Practice Address - Street 1:2452 SOUTHMONT DR
Practice Address - Street 2:APT #206
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7085
Practice Address - Country:US
Practice Address - Phone:423-329-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist