Healthcare Provider Details

I. General information

NPI: 1205751302
Provider Name (Legal Business Name): SANDY GERGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11027 GATO DEL SOL
UNION KY
41091-7815
US

IV. Provider business mailing address

11027 GATO DEL SOL
UNION KY
41091-7815
US

V. Phone/Fax

Practice location:
  • Phone: 727-415-8776
  • Fax:
Mailing address:
  • Phone: 727-415-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025988
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: