Healthcare Provider Details

I. General information

NPI: 1265940183
Provider Name (Legal Business Name): SARA BEKELE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

167 MAIN ST.
TUBA CITY AZ
86045
US

V. Phone/Fax

Practice location:
  • Phone: 602-249-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61356
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number456855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: