Provider Demographics
NPI:1508393836
Name:BIRMINGHAM, SARAH JO (RPH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 STERNS RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9576
Mailing Address - Country:US
Mailing Address - Phone:734-854-7980
Mailing Address - Fax:734-854-2890
Practice Address - Street 1:3462 STERNS RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9576
Practice Address - Country:US
Practice Address - Phone:724-854-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031227671835P2201X
MI53020422111835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care