Provider Demographics
NPI:1932658135
Name:SARAH MOON, LMP
Entity Type:Organization
Organization Name:SARAH MOON, LMP
Other - Org Name:SNOWBERRY APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-799-2738
Mailing Address - Street 1:340 15TH AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5606
Mailing Address - Country:US
Mailing Address - Phone:206-799-2738
Mailing Address - Fax:844-710-6068
Practice Address - Street 1:340 15TH AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5606
Practice Address - Country:US
Practice Address - Phone:206-799-2738
Practice Address - Fax:844-710-6068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA24188261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center