Provider Demographics
NPI:1528310562
Name:FISKUM, SARA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:FISKUM
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 1:7200 VALLEY CREEK PLZ
Mailing Address - Street 2:T-0694
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 VALLEY CREEK PLZ
Practice Address - Street 2:T-0694
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2265
Practice Address - Country:US
Practice Address - Phone:651-735-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-14
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist