Provider Demographics
NPI:1881793768
Name:PIERCE, SANDRA LESLEY (BS)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:LESLEY
Last Name:PIERCE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-1630
Mailing Address - Country:US
Mailing Address - Phone:850-547-9611
Mailing Address - Fax:850-547-9611
Practice Address - Street 1:311 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-1630
Practice Address - Country:US
Practice Address - Phone:850-547-9611
Practice Address - Fax:850-547-9611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist