Provider Demographics
NPI:1093042988
Name:MICHAEL, SANDRA LEE (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:MICHAEL
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 1:1701 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5002
Mailing Address - Country:US
Mailing Address - Phone:940-723-7979
Mailing Address - Fax:940-723-0669
Practice Address - Street 1:1701 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5002
Practice Address - Country:US
Practice Address - Phone:940-723-7979
Practice Address - Fax:940-723-0669
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist