Provider Demographics
NPI:1124303441
Name:PAINTER, SANDRA LUCILE (CPHT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LUCILE
Last Name:PAINTER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3910
Mailing Address - Country:US
Mailing Address - Phone:804-862-8002
Mailing Address - Fax:804-862-8023
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8002
Practice Address - Fax:804-862-8023
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230019120183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0230019120OtherSTATE LICENSE