Provider Demographics
NPI:1376174185
Name:CARL, SARAH TILA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:TILA
Last Name:CARL
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 1:30831 ROCKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3354
Mailing Address - Country:US
Mailing Address - Phone:440-413-6135
Mailing Address - Fax:
Practice Address - Street 1:22001 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1223
Practice Address - Country:US
Practice Address - Phone:313-255-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist