Provider Demographics
NPI:1033317110
Name:JUSTICE, SANDRA
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:JUSTICE
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 1:3550 TEXAS RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8611
Mailing Address - Country:US
Mailing Address - Phone:843-618-3868
Mailing Address - Fax:
Practice Address - Street 1:1530 MCLURE CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6174
Practice Address - Country:US
Practice Address - Phone:843-679-1881
Practice Address - Fax:843-679-1887
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21037183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21037OtherSC BOARD OF PHARMACY TECH