Provider Demographics
NPI:1962130401
Name:KING, SARA LYN (RPH)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LYN
Last Name:KING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BUSINESS PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-2026
Mailing Address - Country:US
Mailing Address - Phone:830-583-9825
Mailing Address - Fax:830-583-9763
Practice Address - Street 1:200 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-2026
Practice Address - Country:US
Practice Address - Phone:830-583-9825
Practice Address - Fax:830-583-9763
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist