Provider Demographics
NPI:1811270184
Name:DEPTULA, SARAH RACHEL VICTORIA (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:SARAH RACHEL
Middle Name:VICTORIA
Last Name:DEPTULA
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 1:2222 MAXCY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2715
Mailing Address - Country:US
Mailing Address - Phone:843-637-1891
Mailing Address - Fax:
Practice Address - Street 1:907 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3919
Practice Address - Country:US
Practice Address - Phone:843-795-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist