Provider Demographics
NPI:1336802313
Name:SAUTER, JEROME
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:SAUTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 107TH STREET CIR E UNIT 109
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-1160
Mailing Address - Country:US
Mailing Address - Phone:570-241-1817
Mailing Address - Fax:
Practice Address - Street 1:240 107TH STREET CIR E UNIT 109
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-1160
Practice Address - Country:US
Practice Address - Phone:570-241-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist