Provider Demographics
NPI:1447598651
Name:ABEYTA, SANDRA L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:ABEYTA
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:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0976
Mailing Address - Country:US
Mailing Address - Phone:575-756-4023
Mailing Address - Fax:
Practice Address - Street 1:6000 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2702
Practice Address - Country:US
Practice Address - Phone:505-899-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000005580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist