Provider Demographics
NPI:1558086868
Name:ANDERSON, SARAH SHORE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:SHORE
Last Name:ANDERSON
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 1:2269 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3020
Mailing Address - Country:US
Mailing Address - Phone:507-273-1274
Mailing Address - Fax:
Practice Address - Street 1:2269 5TH ST
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3020
Practice Address - Country:US
Practice Address - Phone:507-273-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121434OtherPHARMACIST LICENSE NUMBER