Provider Demographics
NPI:1619222825
Name:WURDEMAN, SARA JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JO
Last Name:WURDEMAN
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 1:718 N WASHINGTON ST
Mailing Address - Street 2:T-0532
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3910
Mailing Address - Country:US
Mailing Address - Phone:402-597-9499
Mailing Address - Fax:
Practice Address - Street 1:718 N WASHINGTON ST
Practice Address - Street 2:T-0532
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3910
Practice Address - Country:US
Practice Address - Phone:402-597-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist