Provider Demographics
NPI:1609903509
Name:MIRGAUX, SARAH JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:MIRGAUX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3250 GORDONVILLE RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5056
Mailing Address - Country:US
Mailing Address - Phone:573-339-0999
Mailing Address - Fax:573-334-5993
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:STE. 101
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-339-0999
Practice Address - Fax:573-334-5993
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001023913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist