Provider Demographics
NPI:1093210189
Name:CHAVEZ SANDOVAL, OSCAR PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:PAUL
Last Name:CHAVEZ SANDOVAL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BASSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9135
Mailing Address - Country:US
Mailing Address - Phone:970-631-1659
Mailing Address - Fax:
Practice Address - Street 1:4500 WEITZEL ST
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4416
Practice Address - Country:US
Practice Address - Phone:970-493-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist