Provider Demographics
NPI:1457901811
Name:SABBINENI, SRAVANTHI
Entity Type:Individual
Prefix:
First Name:SRAVANTHI
Middle Name:
Last Name:SABBINENI
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 1:13641 TORRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7394
Mailing Address - Country:US
Mailing Address - Phone:240-328-3821
Mailing Address - Fax:
Practice Address - Street 1:4200 STUART ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5759
Practice Address - Country:US
Practice Address - Phone:903-259-6797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX42560OtherTEXAS STATE BOARD OF PHARMACY