Provider Demographics
NPI:1609478403
Name:JARRELL, SANDY S (RPH)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:S
Last Name:JARRELL
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 1:2018 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5732
Mailing Address - Country:US
Mailing Address - Phone:337-948-8702
Mailing Address - Fax:
Practice Address - Street 1:1629 CRESWELL LN EXT
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-7815
Practice Address - Country:US
Practice Address - Phone:337-942-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.013540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist