Provider Demographics
NPI:1306174545
Name:GIBBONS, SARA CATHERINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:CATHERINE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 BRANCH HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-5000
Mailing Address - Country:US
Mailing Address - Phone:917-370-4483
Mailing Address - Fax:
Practice Address - Street 1:7917 BRANCH HOLLOW TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-5000
Practice Address - Country:US
Practice Address - Phone:817-370-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist