Provider Demographics
NPI:1255617791
Name:STRAUTMAN, SALLY A (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:A
Last Name:STRAUTMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 ARROWHEAD PASS
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4911
Mailing Address - Country:US
Mailing Address - Phone:260-797-9327
Mailing Address - Fax:
Practice Address - Street 1:5112 ARROWHEAD PASS
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4911
Practice Address - Country:US
Practice Address - Phone:260-797-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023349A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist