Provider Demographics
NPI:1306886213
Name:MCLOUD, SANDRA LEE (RPL)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:MCLOUD
Suffix:
Gender:F
Credentials:RPL
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPL
Mailing Address - Street 1:4820 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9711
Mailing Address - Country:US
Mailing Address - Phone:585-554-4593
Mailing Address - Fax:
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:VA MEDICAL CENTER PHARMACY SERVICE 119
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-393-8046
Practice Address - Fax:585-393-8357
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist