Provider Demographics
NPI:1225657059
Name:ROSS, SARAH GERVAIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:GERVAIS
Last Name:ROSS
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 1:115 CALM WATER LOOP
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-2168
Mailing Address - Country:US
Mailing Address - Phone:979-203-1613
Mailing Address - Fax:
Practice Address - Street 1:2508 S DAY ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5521
Practice Address - Country:US
Practice Address - Phone:979-277-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist