Provider Demographics
NPI:1760779227
Name:WORMLEY, SARA SUE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:SUE
Last Name:WORMLEY
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 1:918 W PLATT ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2038
Mailing Address - Country:US
Mailing Address - Phone:563-652-5611
Mailing Address - Fax:
Practice Address - Street 1:918 W PLATT ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2038
Practice Address - Country:US
Practice Address - Phone:563-652-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist