Healthcare Provider Details

I. General information

NPI: 1144319310
Provider Name (Legal Business Name): SANDRA RAHALL TOLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOUIS STOKES VA MEDICAL CENTER 10701 EAST BLVD PHARMACY SERVICE (119W)
CLEVELAND OH
44106
US

IV. Provider business mailing address

10057 VISTA DR
NORTH ROYALTON OH
44133-2362
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-231-3291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number4043
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: