Provider Demographics
NPI:1376866749
Name:VANAUKEN, SANDRA (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:VANAUKEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 3RD AVE EXT
Mailing Address - Street 2:TARGET PHARMACY T-1796
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-5618
Mailing Address - Country:US
Mailing Address - Phone:518-283-2572
Mailing Address - Fax:
Practice Address - Street 1:625 3RD AVE EXT
Practice Address - Street 2:TARGET PHARMACY T-1796
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-5618
Practice Address - Country:US
Practice Address - Phone:518-283-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist