Provider Demographics
NPI:1891066957
Name:BORK, SARA JENEVIEVE DENISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:JENEVIEVE DENISE
Last Name:BORK
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 1:300 MEYERLAND PLAZA MALL
Mailing Address - Street 2:T-1975
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 MEYERLAND PLAZA MALL
Practice Address - Street 2:T-1975
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1611
Practice Address - Country:US
Practice Address - Phone:713-292-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist