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General NPI Number Information
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NPI Number | 1528921137
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Entity Type | Individual
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Provider Name | SANDRIA PARK
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Gender | Female
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 312 SE STONEMILL DR # 105
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City | VANCOUVER
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State | WA
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Zip | 98684-3545
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Country | US
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Telephone | 360-261-6032
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 SW 18TH AVE APT 306
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City | PORTLAND
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State | OR
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Zip | 97205-1754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHARM.PH.61529245
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License Number State | WA
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