Provider Demographics
NPI:1124746813
Name:HILLEBOLD, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HILLEBOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9546 E RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7463
Mailing Address - Country:US
Mailing Address - Phone:480-895-3063
Mailing Address - Fax:
Practice Address - Street 1:9546 E RIGGS RD
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-7463
Practice Address - Country:US
Practice Address - Phone:480-895-3063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist