Provider Demographics
NPI:1578814802
Name:STOLTENBURG, SARAH ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:STOLTENBURG
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 1:1001 13TH ST S
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3254
Mailing Address - Country:US
Mailing Address - Phone:218-741-6603
Mailing Address - Fax:
Practice Address - Street 1:1001 13TH ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3254
Practice Address - Country:US
Practice Address - Phone:218-741-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist