Provider Demographics
NPI:1467733691
Name:BANCHY, SARA RENEE (RPH, PHARM D)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RENEE
Last Name:BANCHY
Suffix:
Gender:F
Credentials:RPH, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 MARSOL RD
Mailing Address - Street 2:APT 623
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3571
Mailing Address - Country:US
Mailing Address - Phone:440-759-9596
Mailing Address - Fax:
Practice Address - Street 1:2135 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2629
Practice Address - Country:US
Practice Address - Phone:216-932-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist