Provider Demographics
NPI:1831739432
Name:SISNEROS, ALEXANDER IGNACIO (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:IGNACIO
Last Name:SISNEROS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 DAZIE JO ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-6273
Mailing Address - Country:US
Mailing Address - Phone:303-261-5210
Mailing Address - Fax:
Practice Address - Street 1:3169 DAZIE JO ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-6273
Practice Address - Country:US
Practice Address - Phone:303-261-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61000583183500000X
CO0023019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist