Provider Demographics
NPI:1609452879
Name:MOHSEN, SARA
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MOHSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 CASTLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-2712
Mailing Address - Country:US
Mailing Address - Phone:817-655-0428
Mailing Address - Fax:
Practice Address - Street 1:2214 PADDOCK WAY DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1005
Practice Address - Country:US
Practice Address - Phone:800-557-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX485801835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric