Provider Demographics
NPI:1245573427
Name:KANG-PAK, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KANG-PAK
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 1:7190 CRESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7314
Mailing Address - Country:US
Mailing Address - Phone:240-529-1800
Mailing Address - Fax:
Practice Address - Street 1:7190 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7314
Practice Address - Country:US
Practice Address - Phone:240-529-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist