Provider Demographics
NPI:1518027523
Name:JUSTICE, SANDRA (RPH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:JUSTICE
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 1:3118 RIVER BAY DR N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2982
Mailing Address - Country:US
Mailing Address - Phone:317-319-4858
Mailing Address - Fax:
Practice Address - Street 1:1101 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3729
Practice Address - Country:US
Practice Address - Phone:317-251-9547
Practice Address - Fax:317-251-9556
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017131A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist