Provider Demographics
NPI:1659975613
Name:BROUILLET, SARAH RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RAE
Last Name:BROUILLET
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:RAE
Other - Last Name:DERAPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 PREBLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2440
Mailing Address - Country:US
Mailing Address - Phone:207-899-0939
Mailing Address - Fax:207-899-0968
Practice Address - Street 1:141 PREBLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2440
Practice Address - Country:US
Practice Address - Phone:207-899-0939
Practice Address - Fax:207-899-0968
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR27896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist