Provider Demographics
NPI:1316347552
Name:SNOTHERLY, SARAH BUMGARDNER (PHARMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BUMGARDNER
Last Name:SNOTHERLY
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 1:1802 N POINTE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3408
Mailing Address - Country:US
Mailing Address - Phone:919-220-6894
Mailing Address - Fax:919-220-6591
Practice Address - Street 1:1802 N POINTE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3408
Practice Address - Country:US
Practice Address - Phone:919-220-6894
Practice Address - Fax:919-220-6591
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0326462Medicaid
NC1193770332Medicare NSC