Provider Demographics
NPI:1225493208
Name:CARROLL, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CARROLL
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 1:725 E VILLA MARIA RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5320
Mailing Address - Country:US
Mailing Address - Phone:979-822-1850
Mailing Address - Fax:979-775-6872
Practice Address - Street 1:725 E VILLA MARIA RD STE 1300
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5320
Practice Address - Country:US
Practice Address - Phone:979-822-1850
Practice Address - Fax:979-775-6872
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist