Provider Demographics
NPI:1255820445
Name:TAMAN, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:TAMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716
Mailing Address - Country:US
Mailing Address - Phone:631-567-1061
Mailing Address - Fax:
Practice Address - Street 1:4621 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:631-567-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist