Provider Demographics
NPI:1871193680
Name:POMRENKE, SANDRA WILSON
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:WILSON
Last Name:POMRENKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6338 HARBOUR TOWN DR
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-7028
Mailing Address - Country:US
Mailing Address - Phone:540-230-8334
Mailing Address - Fax:
Practice Address - Street 1:2400 N FRANKLIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1089
Practice Address - Country:US
Practice Address - Phone:540-381-0826
Practice Address - Fax:540-381-0826
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist