Provider Demographics
NPI:1528190287
Name:BEYER, SANDRA MARIE (PHARMICIST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:BEYER
Suffix:
Gender:F
Credentials:PHARMICIST
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARIE
Other - Last Name:BEYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-9352
Mailing Address - Fax:907-228-9593
Practice Address - Street 1:2960 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5742
Practice Address - Country:US
Practice Address - Phone:907-228-9352
Practice Address - Fax:907-228-9593
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1662OtherLICENSED PHARMACIST