Provider Demographics
NPI:1154658417
Name:BOUCHARD, SARAH LYNN (PHARM D)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:BOUCHARD
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 1:2585 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5203
Mailing Address - Country:US
Mailing Address - Phone:336-584-7265
Mailing Address - Fax:
Practice Address - Street 1:2585 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5203
Practice Address - Country:US
Practice Address - Phone:336-584-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist