Provider Demographics
NPI:1063742294
Name:RUSTAD, SARAH ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:RUSTAD
Suffix:
Gender:F
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 1:89 MEADOWLARK LN N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2149
Mailing Address - Country:US
Mailing Address - Phone:701-866-3976
Mailing Address - Fax:
Practice Address - Street 1:706 38TH ST N STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2953
Practice Address - Country:US
Practice Address - Phone:701-893-9050
Practice Address - Fax:855-826-2596
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120245183500000X
ND5222183500000X
AZS016622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist