Healthcare Provider Details

I. General information

NPI: 1780722496
Provider Name (Legal Business Name): SALLY SANCHEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 CONSTITUTION PL NE
ALBUQUERQUE NM
87110-7656
US

IV. Provider business mailing address

6407 PEPPERDINE ST NE
ALBUQUERQUE NM
87111-1215
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2402
  • Fax:
Mailing address:
  • Phone: 505-822-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number4112
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: