Provider Demographics
NPI:1831475110
Name:WESSON, SANDRA J (PHARM D)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:WESSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 SUSAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-2553
Mailing Address - Country:US
Mailing Address - Phone:402-639-7511
Mailing Address - Fax:402-408-0767
Practice Address - Street 1:11343 S 96TH ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4280
Practice Address - Country:US
Practice Address - Phone:402-408-0761
Practice Address - Fax:402-408-0767
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist