Provider Demographics
NPI:1164770665
Name:PEDERSEN, SARAH R (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:PEDERSEN
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 1:4930 TALL TIMBER DR
Mailing Address - Street 2:201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-6039
Mailing Address - Country:US
Mailing Address - Phone:262-993-6312
Mailing Address - Fax:
Practice Address - Street 1:4930 TALL TIMBER DR
Practice Address - Street 2:201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-6039
Practice Address - Country:US
Practice Address - Phone:262-993-6312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21607183500000X
WI16069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist