Provider Demographics
NPI:1477944882
Name:MYRNA, SARAH JACQUELINE
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JACQUELINE
Last Name:MYRNA
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 1:56 MARSH HEN CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5297
Mailing Address - Country:US
Mailing Address - Phone:706-621-9803
Mailing Address - Fax:
Practice Address - Street 1:3487 CYPRESS MILL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2857
Practice Address - Country:US
Practice Address - Phone:912-265-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist