Provider Demographics
NPI:1326690488
Name:RICKLES, SANDI
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:
Last Name:RICKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3719
Mailing Address - Country:US
Mailing Address - Phone:828-468-6243
Mailing Address - Fax:
Practice Address - Street 1:1818 NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3719
Practice Address - Country:US
Practice Address - Phone:828-468-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist