Healthcare Provider Details

I. General information

NPI: 1316569544
Provider Name (Legal Business Name): SARAH RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HARRY HINES BLVD
DALLAS TX
75235-7709
US

IV. Provider business mailing address

2117 IRONSIDE DR
THE COLONY TX
75056-4215
US

V. Phone/Fax

Practice location:
  • Phone: 469-419-1819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: