Provider Demographics
NPI:1306282587
Name:VILLA, SANDRA CORINA (RPH)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:CORINA
Last Name:VILLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14249 MAYA ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2634
Mailing Address - Country:US
Mailing Address - Phone:915-856-7444
Mailing Address - Fax:
Practice Address - Street 1:8061 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-4705
Practice Address - Country:US
Practice Address - Phone:915-859-7545
Practice Address - Fax:915-859-9862
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist