Provider Demographics
NPI:1669813200
Name:TAM, SARA C (PHARM D)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:C
Last Name:TAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9405 WEST RUSSELL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4024
Mailing Address - Country:US
Mailing Address - Phone:702-883-0153
Mailing Address - Fax:
Practice Address - Street 1:9405 WEST RUSSELL ROAD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4024
Practice Address - Country:US
Practice Address - Phone:702-883-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist