Provider Demographics
NPI:1417232554
Name:STAPLETON, SARAH TANZANIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:TANZANIA
Last Name:STAPLETON
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 1:6260 LACY CV
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-2467
Mailing Address - Country:US
Mailing Address - Phone:601-316-8611
Mailing Address - Fax:
Practice Address - Street 1:1780 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5030
Practice Address - Country:US
Practice Address - Phone:901-756-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34550183500000X
MSE-010751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist