Provider Demographics
NPI:1295274173
Name:FETTY, SARAH M
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:M
Last Name:FETTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:M
Other - Last Name:MINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3033 W PRESIDENT GEORGE BUSH HWY STE 100B
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-5884
Mailing Address - Country:US
Mailing Address - Phone:888-588-1072
Mailing Address - Fax:855-862-4373
Practice Address - Street 1:3033 W PRESIDENT GEORGE BUSH HWY STE 100B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5884
Practice Address - Country:US
Practice Address - Phone:888-588-1072
Practice Address - Fax:855-862-4373
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist