Provider Demographics
NPI:1336631415
Name:NOTTINGHAM, SARAH LETHA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LETHA
Last Name:NOTTINGHAM
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 1:78 PERRY WINKLE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-9506
Mailing Address - Country:US
Mailing Address - Phone:304-736-8310
Mailing Address - Fax:
Practice Address - Street 1:78 PERRY WINKLE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-9506
Practice Address - Country:US
Practice Address - Phone:304-736-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist