Provider Demographics
NPI:1205439791
Name:MULROONEY, SARAH MARTHA
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARTHA
Last Name:MULROONEY
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 1:10955 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1134
Mailing Address - Country:US
Mailing Address - Phone:317-385-8828
Mailing Address - Fax:
Practice Address - Street 1:2460 E WABASH ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-9429
Practice Address - Country:US
Practice Address - Phone:765-654-4056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021798A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist