Provider Demographics
NPI:1164796975
Name:REYNOLDS, SANDRA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANN
Last Name:REYNOLDS
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 1:4299 GUIDE MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6475
Mailing Address - Country:US
Mailing Address - Phone:360-738-7851
Mailing Address - Fax:
Practice Address - Street 1:4299 GUIDE MERIDIAN
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6475
Practice Address - Country:US
Practice Address - Phone:360-738-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist