Provider Demographics
NPI:1104035278
Name:CONNELL, SANDRA IND (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:IND
Last Name:CONNELL
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 1:2064 PROMONTORY POINT LN
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7277
Mailing Address - Country:US
Mailing Address - Phone:916-631-1338
Mailing Address - Fax:
Practice Address - Street 1:2064 PROMONTORY POINT LN
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-7277
Practice Address - Country:US
Practice Address - Phone:916-631-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist