Provider Demographics
NPI:1073220679
Name:QUEEN, SARRYSA ANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARRYSA
Middle Name:ANNE
Last Name:QUEEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SARRYSA
Other - Middle Name:ANNE
Other - Last Name:EAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:582 LUCKY 13 RD
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-6383
Mailing Address - Country:US
Mailing Address - Phone:903-821-3296
Mailing Address - Fax:
Practice Address - Street 1:4160 TOWN CTR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2567
Practice Address - Country:US
Practice Address - Phone:903-892-4416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist