Provider Demographics
NPI:1336417237
Name:CHELLEVOLD, SARA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:CHELLEVOLD
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 1:2931 S FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6499
Mailing Address - Country:US
Mailing Address - Phone:608-277-0087
Mailing Address - Fax:608-277-0162
Practice Address - Street 1:2931 S FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-6499
Practice Address - Country:US
Practice Address - Phone:608-277-0087
Practice Address - Fax:608-277-0162
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14668-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist