Provider Demographics
NPI:1710200944
Name:DEVADAS, SARA MINI (RPH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MINI
Last Name:DEVADAS
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 1:8911 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1674
Mailing Address - Country:US
Mailing Address - Phone:718-426-2508
Mailing Address - Fax:
Practice Address - Street 1:8911 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1674
Practice Address - Country:US
Practice Address - Phone:718-426-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist