Provider Demographics
NPI:1265063432
Name:HA, SANDY (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:HA
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 1:701 RIO RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7018
Mailing Address - Country:US
Mailing Address - Phone:909-634-3152
Mailing Address - Fax:909-634-3162
Practice Address - Street 1:701 RIO RANCHO RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7018
Practice Address - Country:US
Practice Address - Phone:909-634-3152
Practice Address - Fax:909-634-3162
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist