Provider Demographics
NPI:1194313965
Name:WADE, SANDRA N (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:N
Last Name:WADE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 HARRISBURG RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8782
Mailing Address - Country:US
Mailing Address - Phone:870-203-7087
Mailing Address - Fax:870-203-7088
Practice Address - Street 1:3319 HARRISBURG RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8782
Practice Address - Country:US
Practice Address - Phone:870-203-7087
Practice Address - Fax:870-203-7088
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017025932183500000X
ARPD14114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist