Provider Demographics
NPI:1013313584
Name:SABIN, TRISTAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:SABIN
Suffix:
Gender:M
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 1:220 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:WI
Mailing Address - Zip Code:53910-9459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:WI
Practice Address - Zip Code:53910-9459
Practice Address - Country:US
Practice Address - Phone:608-339-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17510-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist