Healthcare Provider Details

I. General information

NPI: 1073833430
Provider Name (Legal Business Name): THOMAS PAUL SANDALA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E PITTSBURGH ST
GREENSBURG PA
15601-2602
US

IV. Provider business mailing address

314 E PITTSBURGH ST
GREENSBURG PA
15601-2602
US

V. Phone/Fax

Practice location:
  • Phone: 724-834-0960
  • Fax: 724-834-8239
Mailing address:
  • Phone: 724-834-0960
  • Fax: 724-834-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP033361L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: