Provider Demographics
NPI:1215328935
Name:CARROLL, SANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CARROLL
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 1:13000 ADMIRALTY WAY
Mailing Address - Street 2:UNIT C-102
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6259
Mailing Address - Country:US
Mailing Address - Phone:206-890-1205
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WASHINGTON
Practice Address - Street 2:BOX 357631
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-890-1205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60240242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist