Provider Demographics
NPI:1902190077
Name:JESTER, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:322 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-4622
Mailing Address - Country:US
Mailing Address - Phone:765-252-0810
Mailing Address - Fax:765-319-7899
Practice Address - Street 1:322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4622
Practice Address - Country:US
Practice Address - Phone:765-252-0810
Practice Address - Fax:765-319-7899
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022589A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist