Provider Demographics
NPI:1346527736
Name:SANDBERG, MELANIE JANE (RPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANE
Last Name:SANDBERG
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 1:128 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-7954
Mailing Address - Country:US
Mailing Address - Phone:919-539-1156
Mailing Address - Fax:
Practice Address - Street 1:2960 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-8348
Practice Address - Country:US
Practice Address - Phone:910-424-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist