Provider Demographics
NPI:1831434810
Name:LIGHT, SANDRA (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:LIGHT
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 1:4846 WILDE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3539
Mailing Address - Country:US
Mailing Address - Phone:941-923-3507
Mailing Address - Fax:
Practice Address - Street 1:8750 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3720
Practice Address - Country:US
Practice Address - Phone:941-756-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist