Provider Demographics
NPI:1891071031
Name:AMBROSE, SARAH A (PHARM D)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOWER MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1030
Mailing Address - Country:US
Mailing Address - Phone:207-865-0205
Mailing Address - Fax:207-865-0567
Practice Address - Street 1:200 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1030
Practice Address - Country:US
Practice Address - Phone:207-865-0205
Practice Address - Fax:207-865-0567
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist