Provider Demographics
NPI:1154127348
Name:EVANS, SANDRA GLADYS (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:GLADYS
Last Name:EVANS
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:GLADYS
Other - Last Name:OBLEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:65 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3105
Mailing Address - Country:US
Mailing Address - Phone:315-529-0808
Mailing Address - Fax:
Practice Address - Street 1:6700 THOMPSON RD STE 7
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211-2171
Practice Address - Country:US
Practice Address - Phone:315-437-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist