Provider Demographics
NPI:1134558232
Name:DE VANDY, ELISABELLE SORIYA SISSI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELISABELLE
Middle Name:SORIYA SISSI
Last Name:DE VANDY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SORIYA
Other - Middle Name:K
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1870 JEFFERSON ST APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1193
Mailing Address - Country:US
Mailing Address - Phone:310-883-5788
Mailing Address - Fax:
Practice Address - Street 1:740 W ALLUVIAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5509
Practice Address - Country:US
Practice Address - Phone:800-797-3543
Practice Address - Fax:877-222-7764
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47815183500000X, 1835P1200X, 1835P0018X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835X0200XPharmacy Service ProvidersPharmacistOncology