Provider Demographics
NPI:1295025302
Name:TABAK, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:TABAK
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 1:7684 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4035
Mailing Address - Country:US
Mailing Address - Phone:330-651-2246
Mailing Address - Fax:
Practice Address - Street 1:540 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2545
Practice Address - Country:US
Practice Address - Phone:330-782-0807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist