MEDICARE: SARA ELIZABETH CHEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	55100	TX

General Provider Information

NPI Number	:	1447881586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ELIZABETH CHEN

Provider Business Mailing Address
First Line	:	2812 TERROSA RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-0074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 E BROAD ST
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5629
Country	:	US
Telephone Number	:	817-435-5418
Fax Number	:	817-435-5420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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Directions to “ SARA ELIZABETH CHEN ” Practice Location

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