Provider Demographics
NPI:1841584687
Name:SANDSMARK, LINDSEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:SANDSMARK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:NOKLEBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1400A TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1004
Mailing Address - Country:US
Mailing Address - Phone:941-255-1682
Mailing Address - Fax:941-255-1682
Practice Address - Street 1:1400A TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1004
Practice Address - Country:US
Practice Address - Phone:941-255-1682
Practice Address - Fax:941-255-1682
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist