Provider Demographics
NPI:1265219919
Name:STEIN, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA KATHRINA
Other - Middle Name:MIRANDA
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7440 HUNDRED ACRE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-9505
Mailing Address - Country:US
Mailing Address - Phone:775-440-0925
Mailing Address - Fax:
Practice Address - Street 1:250 VISTA KNOLL PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5594
Practice Address - Country:US
Practice Address - Phone:775-332-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist