Provider Demographics
NPI:1013123348
Name:OFFUTT, SANDRA LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEIGH
Last Name:OFFUTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15392 COUNTY ROAD 11
Mailing Address - Street 2:PO BOX 150
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-8805
Mailing Address - Country:US
Mailing Address - Phone:701-352-2539
Mailing Address - Fax:701-352-2539
Practice Address - Street 1:701 W 6TH ST
Practice Address - Street 2:PHARMACY DEPT - HEALTH SERVICE CENTER
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-1379
Practice Address - Country:US
Practice Address - Phone:701-352-4216
Practice Address - Fax:701-352-4439
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND4235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist