Provider Demographics
NPI:1417318510
Name:PHELPS, SARA C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:C
Last Name:PHELPS
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 1:175 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2300
Mailing Address - Country:US
Mailing Address - Phone:609-953-7692
Mailing Address - Fax:609-714-9609
Practice Address - Street 1:175 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2300
Practice Address - Country:US
Practice Address - Phone:609-953-7692
Practice Address - Fax:609-714-9609
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03178300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist