Provider Demographics
NPI:1174281620
Name:SANDOVAL, KARISSA T (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:T
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:T
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9258 ROCKHURST ST UNIT 404
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2683
Mailing Address - Country:US
Mailing Address - Phone:505-901-8072
Mailing Address - Fax:
Practice Address - Street 1:9390 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-5037
Practice Address - Country:US
Practice Address - Phone:303-683-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0023856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist