Provider Demographics
NPI:1093083628
Name:PELTZ, SANDRA EVELYN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:EVELYN
Last Name:PELTZ
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 1:110 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3695
Mailing Address - Country:US
Mailing Address - Phone:650-367-0431
Mailing Address - Fax:
Practice Address - Street 1:1601 COLEMAN AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-3122
Practice Address - Country:US
Practice Address - Phone:408-988-0565
Practice Address - Fax:408-567-9061
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist