Provider Demographics
NPI:1629531421
Name:PANNELL, SARA REBECCA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:REBECCA
Last Name:PANNELL
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 1:4415 EMERALD LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5545
Mailing Address - Country:US
Mailing Address - Phone:806-632-6760
Mailing Address - Fax:
Practice Address - Street 1:3145 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:817-453-6015
Practice Address - Fax:817-453-6016
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist