Provider Demographics
NPI:1033453055
Name:CENTELL, SANDRA LEIGH (RPHT, CPHT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEIGH
Last Name:CENTELL
Suffix:
Gender:F
Credentials:RPHT, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CARE CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2105
Mailing Address - Country:US
Mailing Address - Phone:806-350-6352
Mailing Address - Fax:806-350-6340
Practice Address - Street 1:3 CARE CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2105
Practice Address - Country:US
Practice Address - Phone:806-350-6352
Practice Address - Fax:806-350-6340
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113287183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician