Provider Demographics
NPI:1124029855
Name:DWYER, SANDRA DOROTHY (RPH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:DOROTHY
Last Name:DWYER
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 1:2564 OURLAND ACRES
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381
Mailing Address - Country:US
Mailing Address - Phone:248-685-2211
Mailing Address - Fax:
Practice Address - Street 1:249 OUR LAND LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-2539
Practice Address - Country:US
Practice Address - Phone:248-685-2211
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist