Provider Demographics
NPI:1134447352
Name:SANDVIG, JEANNE L (RP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:SANDVIG
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 BARBADOS AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5336
Mailing Address - Country:US
Mailing Address - Phone:714-893-0166
Mailing Address - Fax:714-893-0166
Practice Address - Street 1:6400 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1553
Practice Address - Country:US
Practice Address - Phone:562-425-2713
Practice Address - Fax:562-425-9713
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist