Provider Demographics
NPI:1013519206
Name:HO, SARA BRABOY
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BRABOY
Last Name:HO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 LAKELINE MALL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5924
Mailing Address - Country:US
Mailing Address - Phone:512-872-8450
Mailing Address - Fax:
Practice Address - Street 1:10901 LAKELINE MALL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5924
Practice Address - Country:US
Practice Address - Phone:512-872-8450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist