Provider Demographics
NPI:1043589542
Name:SANDLAK, RENEE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:SANDLAK
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LAMPLIGHTER RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2072
Mailing Address - Country:US
Mailing Address - Phone:407-435-0543
Mailing Address - Fax:
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-2072
Practice Address - Country:US
Practice Address - Phone:407-435-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist