Provider Demographics
NPI:1154042034
Name:MUNSON, SARA (RPH)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 ONEIL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-3316
Mailing Address - Country:US
Mailing Address - Phone:518-534-3180
Mailing Address - Fax:
Practice Address - Street 1:112 NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-3933
Practice Address - Country:US
Practice Address - Phone:518-562-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI069411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist