Provider Demographics
NPI:1659053270
Name:MICAIAH, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MICAIAH
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 1:416 NORTHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4238
Mailing Address - Country:US
Mailing Address - Phone:973-289-3182
Mailing Address - Fax:
Practice Address - Street 1:2650 US HIGHWAY 130 STE D
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3327
Practice Address - Country:US
Practice Address - Phone:732-807-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04187400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist