Provider Demographics
NPI:1841745064
Name:BARDAS, SANDRA LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEIGH
Last Name:BARDAS
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 1:1343 HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4218
Mailing Address - Country:US
Mailing Address - Phone:650-326-1949
Mailing Address - Fax:
Practice Address - Street 1:1343 HOOVER ST
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4218
Practice Address - Country:US
Practice Address - Phone:650-326-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH32539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist