Provider Demographics
NPI:1609301571
Name:GOULD, SASHA JORDAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:JORDAN
Last Name:GOULD
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 1:1057 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2428
Mailing Address - Country:US
Mailing Address - Phone:707-678-4412
Mailing Address - Fax:707-678-8823
Practice Address - Street 1:1057 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2428
Practice Address - Country:US
Practice Address - Phone:707-678-4412
Practice Address - Fax:707-678-8823
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist