Provider Demographics
NPI:1437432788
Name:TELLEZ, SARA KAY (RPH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:KAY
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5198 ELKHART ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-6054
Mailing Address - Country:US
Mailing Address - Phone:303-501-4792
Mailing Address - Fax:
Practice Address - Street 1:15301 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-3064
Practice Address - Country:US
Practice Address - Phone:303-751-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist