Provider Demographics
NPI:1114514692
Name:SANDSTROM, ROBERT H
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:SANDSTROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 CTY RD 728
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740
Mailing Address - Country:US
Mailing Address - Phone:479-737-5493
Mailing Address - Fax:
Practice Address - Street 1:2785 CTY RD 728
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740
Practice Address - Country:US
Practice Address - Phone:479-737-5493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist