Provider Demographics
NPI:1124350145
Name:SANDEEN, GARY CHARLES (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:CHARLES
Last Name:SANDEEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CASSADAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14718-9722
Mailing Address - Country:US
Mailing Address - Phone:716-595-3061
Mailing Address - Fax:716-366-4047
Practice Address - Street 1:3955 VINEYARD DR
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-3572
Practice Address - Country:US
Practice Address - Phone:716-366-2624
Practice Address - Fax:716-366-4047
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035577-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist