Healthcare Provider Details

I. General information

NPI: 1861734238
Provider Name (Legal Business Name): RUBY JAQUELINE LLAMAS-SANDOVAL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

1519 MCDOUGAL ST
VALLEJO CA
94590-3061
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7131
  • Fax:
Mailing address:
  • Phone: 707-628-2528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: