Provider Demographics
NPI:1235852229
Name:MIHULKA, SARAH ANNE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:MIHULKA
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 1:202 N MILL ST APT 8
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1856
Mailing Address - Country:US
Mailing Address - Phone:541-337-5223
Mailing Address - Fax:
Practice Address - Street 1:825 SE BISHOP BLVD STE 301
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-332-4608
Practice Address - Fax:509-332-3341
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10312183500000X
WAPH61307177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist