Provider Demographics
NPI:1639447741
Name:TANTILLO, SARAH MARTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARTIN
Last Name:TANTILLO
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 1:9100 POCAHONTAS TRL
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-3401
Mailing Address - Country:US
Mailing Address - Phone:804-966-2151
Mailing Address - Fax:
Practice Address - Street 1:14440 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3719
Practice Address - Country:US
Practice Address - Phone:757-874-5084
Practice Address - Fax:757-875-0280
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232908183500000X
VA0202209521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist