Provider Demographics
NPI:1184394819
Name:BALLOU, SARAH LAUREN (PHARMD, MPH)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LAUREN
Last Name:BALLOU
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LAUREN
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:677 S LOWELL ST APT 654
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4818
Mailing Address - Country:US
Mailing Address - Phone:360-201-7325
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist