Provider Demographics
NPI:1801102496
Name:ILL, SANDRA VUCINOVICH (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:VUCINOVICH
Last Name:ILL
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 1:7000 YORK AVE S
Mailing Address - Street 2:T-2313
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4213
Mailing Address - Country:US
Mailing Address - Phone:952-925-4610
Mailing Address - Fax:
Practice Address - Street 1:7000 YORK AVE S
Practice Address - Street 2:T-2313
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4213
Practice Address - Country:US
Practice Address - Phone:952-925-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18915183500000X
MN119844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist