Provider Demographics
NPI:1295414878
Name:EL-KOUBYSI, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:EL-KOUBYSI
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 1:444 N CENTRAL AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4013
Mailing Address - Country:US
Mailing Address - Phone:785-249-1597
Mailing Address - Fax:
Practice Address - Street 1:535 NW 9TH ST STE 205
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1077
Practice Address - Country:US
Practice Address - Phone:405-772-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist