Healthcare Provider Details

I. General information

NPI: 1952889388
Provider Name (Legal Business Name): SANDRA DE ANDA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

IV. Provider business mailing address

6409 LOS ROBLES DR
EL PASO TX
79912-2921
US

V. Phone/Fax

Practice location:
  • Phone: 915-569-4425
  • Fax: 915-742-0080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number626254
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: