Provider Demographics
NPI:1811235013
Name:BROTEN, SARA B (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:BROTEN
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 1:111 MAIN AVE S
Mailing Address - Street 2:
Mailing Address - City:ROSEAU
Mailing Address - State:MN
Mailing Address - Zip Code:56751-1421
Mailing Address - Country:US
Mailing Address - Phone:218-463-2465
Mailing Address - Fax:218-463-2875
Practice Address - Street 1:111 MAIN AVE S
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1421
Practice Address - Country:US
Practice Address - Phone:218-463-2465
Practice Address - Fax:218-463-2875
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist