Provider Demographics
NPI:1184782179
Name:BANG, SANDRA LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:BANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 S STEEN RD
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9253
Mailing Address - Country:US
Mailing Address - Phone:509-922-1105
Mailing Address - Fax:
Practice Address - Street 1:510 E 37TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2701
Practice Address - Country:US
Practice Address - Phone:509-455-4437
Practice Address - Fax:509-455-4435
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist