Provider Demographics
NPI:1396843124
Name:HUNTLEY, SANDRA DENISE (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:HUNTLEY
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 1:14829 LONDON LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2547
Mailing Address - Country:US
Mailing Address - Phone:301-262-0534
Mailing Address - Fax:
Practice Address - Street 1:14829 LONDON LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-2547
Practice Address - Country:US
Practice Address - Phone:301-262-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist