Healthcare Provider Details

I. General information

NPI: 1902190077
Provider Name (Legal Business Name): SARAH JESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH CRAWFORD

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 N MAIN ST
KOKOMO IN
46901-4622
US

IV. Provider business mailing address

322 N MAIN ST
KOKOMO IN
46901-4622
US

V. Phone/Fax

Practice location:
  • Phone: 765-252-0810
  • Fax: 765-319-7899
Mailing address:
  • Phone: 765-252-0810
  • Fax: 765-319-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26022589A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: