Provider Demographics
NPI:1699166090
Name:FIETZER, SARA (PHARM D)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:FIETZER
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 1:760 W JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-2016
Mailing Address - Country:US
Mailing Address - Phone:920-929-7422
Mailing Address - Fax:920-929-9810
Practice Address - Street 1:760 W JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2016
Practice Address - Country:US
Practice Address - Phone:920-929-7422
Practice Address - Fax:920-929-9810
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15596-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist