Provider Demographics
NPI:1477603975
Name:SANCHEZ, MIRIAM RAQUELY
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:RAQUELY
Last Name:SANCHEZ
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 1:2670 LENOX DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-1709
Mailing Address - Country:US
Mailing Address - Phone:770-530-5459
Mailing Address - Fax:
Practice Address - Street 1:1077 JESSE JEWELL PKWY SW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-6103
Practice Address - Country:US
Practice Address - Phone:770-536-3329
Practice Address - Fax:770-536-0462
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA330101051154866183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician