Healthcare Provider Details

I. General information

NPI: 1851927073
Provider Name (Legal Business Name): SARA COUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

IV. Provider business mailing address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-3731
  • Fax: 208-265-1031
Mailing address:
  • Phone: 208-265-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP5842
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: