Provider Demographics
NPI:1235864513
Name:MASK, SARA ANNE (RPH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE
Last Name:MASK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4105 WESTCOR CT STE 1
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2874
Mailing Address - Country:US
Mailing Address - Phone:319-545-5100
Mailing Address - Fax:319-545-5103
Practice Address - Street 1:4105 WESTCOR CT STE 1
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2874
Practice Address - Country:US
Practice Address - Phone:319-545-5100
Practice Address - Fax:319-545-5103
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA187051835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric