Provider Demographics
NPI:1780980060
Name:TRUJILLO, SANDRA L (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:TRUJILLO
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 1:6711 NE 63RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-1997
Mailing Address - Country:US
Mailing Address - Phone:360-992-5686
Mailing Address - Fax:360-992-5688
Practice Address - Street 1:6711 NE 63RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-1997
Practice Address - Country:US
Practice Address - Phone:360-992-5686
Practice Address - Fax:360-992-5688
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA15405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist