Provider Demographics
NPI:1609080738
Name:SANDLIN, ANGELA WHITE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:WHITE
Last Name:SANDLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 INSPIRATION WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-3990
Mailing Address - Country:US
Mailing Address - Phone:502-333-2722
Mailing Address - Fax:502-222-8684
Practice Address - Street 1:1025 NEW MOODY LN
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9154
Practice Address - Country:US
Practice Address - Phone:502-222-3362
Practice Address - Fax:502-222-8684
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY08935OtherPHARMACIST LICENSE NUMBER