Healthcare Provider Details

I. General information

NPI: 1336697978
Provider Name (Legal Business Name): SANDY CERVANTES PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 S LINDSAY RD
GILBERT AZ
85295-4744
US

IV. Provider business mailing address

451 E MCKINLEY ST
TEMPE AZ
85281-1026
US

V. Phone/Fax

Practice location:
  • Phone: 480-857-1801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021790
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: