Provider Demographics
NPI:1922653716
Name:SANDOVAL, NATIVIDAD III (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NATIVIDAD
Middle Name:
Last Name:SANDOVAL
Suffix:III
Gender:M
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:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:OLTON
Mailing Address - State:TX
Mailing Address - Zip Code:79064-0305
Mailing Address - Country:US
Mailing Address - Phone:806-292-6240
Mailing Address - Fax:
Practice Address - Street 1:2403 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-3119
Practice Address - Country:US
Practice Address - Phone:806-293-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist