Provider Demographics
NPI:1437403318
Name:RIEBOLDT, SARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:RIEBOLDT
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:N66W25201 COUNTY HIGHWAY VV
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-2677
Mailing Address - Country:US
Mailing Address - Phone:262-820-2611
Mailing Address - Fax:262-820-2592
Practice Address - Street 1:N65W24838 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-2670
Practice Address - Country:US
Practice Address - Phone:262-946-6363
Practice Address - Fax:262-946-6364
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14416-0401835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist