Provider Demographics
NPI:1619276326
Name:SANDFORD, BRIAN DAVID
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:SANDFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1248
Mailing Address - Country:US
Mailing Address - Phone:330-637-0716
Mailing Address - Fax:330-872-0521
Practice Address - Street 1:325 W BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1272
Practice Address - Country:US
Practice Address - Phone:330-872-4442
Practice Address - Fax:330-872-0521
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist