Provider Demographics
NPI:1629377205
Name:MCCRACKEN, SANDRA NICHOLS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:NICHOLS
Last Name:MCCRACKEN
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 1:4511 JOHN TYLER HWY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2415
Mailing Address - Country:US
Mailing Address - Phone:757-253-8003
Mailing Address - Fax:757-220-4609
Practice Address - Street 1:4511 JOHN TYLER HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2415
Practice Address - Country:US
Practice Address - Phone:757-253-8003
Practice Address - Fax:757-220-4609
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist