Provider Demographics
NPI:1841401601
Name:PUTERBAUGH, SARA JEANNE (RPH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:JEANNE
Last Name:PUTERBAUGH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17518 IDA CENTER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9749
Mailing Address - Country:US
Mailing Address - Phone:734-279-2869
Mailing Address - Fax:
Practice Address - Street 1:833 W ALEXIS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-4303
Practice Address - Country:US
Practice Address - Phone:419-269-6909
Practice Address - Fax:419-269-6911
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-17849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist