Healthcare Provider Details

I. General information

NPI: 1982036711
Provider Name (Legal Business Name): SARAH CRUZ PHARMD, RD, CNSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

1505 AZALEA HILL DRIVE
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-8815
  • Fax:
Mailing address:
  • Phone: 352-226-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number35828
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: