Provider Demographics
NPI:1205146909
Name:MADDOX, SARAH JUDITH (RPH)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JUDITH
Last Name:MADDOX
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 1:18900 HIGHWAY 105 W
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-6081
Mailing Address - Country:US
Mailing Address - Phone:936-582-0002
Mailing Address - Fax:
Practice Address - Street 1:18900 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-6081
Practice Address - Country:US
Practice Address - Phone:936-582-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist