Provider Demographics
NPI:1063605855
Name:BERRY, SANDRA KAY (PHARM D)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3895 UPHAM ST
Mailing Address - Street 2:SUITE 060
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4651
Mailing Address - Country:US
Mailing Address - Phone:303-252-7990
Mailing Address - Fax:303-252-7991
Practice Address - Street 1:3895 UPHAM ST
Practice Address - Street 2:SUITE 060
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4651
Practice Address - Country:US
Practice Address - Phone:303-252-7990
Practice Address - Fax:303-252-7991
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist