Provider Demographics
NPI:1639164551
Name:WYNN, SARAH ELIZABETH (PHARM D, RPH)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:WYNN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5809 GLEN EAGLES DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6899
Mailing Address - Country:US
Mailing Address - Phone:540-548-2813
Mailing Address - Fax:540-785-1183
Practice Address - Street 1:3102 PLANK RD
Practice Address - Street 2:#600
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4954
Practice Address - Country:US
Practice Address - Phone:540-785-1162
Practice Address - Fax:540-785-1183
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202205865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist