Provider Demographics
NPI:1477032852
Name:POLLMANN, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:POLLMANN
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 1:12921 ENTERPRISE WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-1206
Mailing Address - Country:US
Mailing Address - Phone:314-344-9604
Mailing Address - Fax:
Practice Address - Street 1:1332 N ELM ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1080
Practice Address - Country:US
Practice Address - Phone:618-979-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist