Healthcare Provider Details

I. General information

NPI: 1295037976
Provider Name (Legal Business Name): SARAH786 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 EASTERN AVE
BALTIMORE MD
21231-3113
US

IV. Provider business mailing address

2245 EASTERN AVE
BALTIMORE MD
21231-3113
US

V. Phone/Fax

Practice location:
  • Phone: 410-675-6046
  • Fax: 410-563-1147
Mailing address:
  • Phone: 410-675-6046
  • Fax: 410-563-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHNR001430
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number214001717
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP05416
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNP000629
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number64001534A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNRX0000846
License Number StateDC

VIII. Authorized Official

Name: SYED SHAH
Title or Position: PRESIDENT
Credential:
Phone: 954-288-5257