Provider Demographics
NPI:1083619738
Name:DIRKS, SANDRA J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:DIRKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 SW KENNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-1044
Mailing Address - Country:US
Mailing Address - Phone:515-282-2245
Mailing Address - Fax:
Practice Address - Street 1:2507 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50311-4516
Practice Address - Country:US
Practice Address - Phone:515-282-2245
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16559183500000X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric