Provider Demographics
NPI:1811698418
Name:MANSOUR, SARAH MOHAMED TAWF
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MOHAMED TAWF
Last Name:MANSOUR
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 1:124 W VERANO CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95391-2014
Mailing Address - Country:US
Mailing Address - Phone:805-744-9903
Mailing Address - Fax:
Practice Address - Street 1:124 W VERANO CT
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95391-2014
Practice Address - Country:US
Practice Address - Phone:805-744-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist