Provider Demographics
NPI:1043807373
Name:BLASIG, SANDRA (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BLASIG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKSHIRE BROTHERS PHARMACY #44
Mailing Address - Street 2:455 STATE HIGHWAY 36 N.
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836
Mailing Address - Country:US
Mailing Address - Phone:979-567-1446
Mailing Address - Fax:979-567-9437
Practice Address - Street 1:455 STATE HIGHWAY 36 N
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-7552
Practice Address - Country:US
Practice Address - Phone:979-567-1446
Practice Address - Fax:979-567-9437
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26339OtherTEXAS STATE BOARD OF PHARMACY