Provider Demographics
NPI:1932939386
Name:KASPERIAN, SARAI CASTILLO
Entity type:Individual
Prefix:
First Name:SARAI
Middle Name:CASTILLO
Last Name:KASPERIAN
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 1:126 KASPERIAN LN NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-5334
Mailing Address - Country:US
Mailing Address - Phone:912-237-6949
Mailing Address - Fax:
Practice Address - Street 1:555 W OGLETHORPE HWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4447
Practice Address - Country:US
Practice Address - Phone:912-876-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist