Provider Demographics
NPI:1811532708
Name:COULTER, SARA (PHARMD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:COULTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HARDING AVE APT 1G
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1724
Mailing Address - Country:US
Mailing Address - Phone:347-752-3451
Mailing Address - Fax:
Practice Address - Street 1:350 S BROADWAY
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5601
Practice Address - Country:US
Practice Address - Phone:914-333-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist