Provider Demographics
NPI:1831933225
Name:GREEN, SARA DOROTHY
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:DOROTHY
Last Name:GREEN
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 1:7115 S MASON RD APT 512
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4477
Mailing Address - Country:US
Mailing Address - Phone:816-922-9977
Mailing Address - Fax:
Practice Address - Street 1:4650 WESTWAY PARK BLVD STE 206
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-2006
Practice Address - Country:US
Practice Address - Phone:713-461-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist