Provider Demographics
NPI:1386049559
Name:TROMBLEY, SANDRA (PHARM D)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:TROMBLEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ROSE
Other - Last Name:HROMEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E VIENNA ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1421
Mailing Address - Country:US
Mailing Address - Phone:810-687-6680
Mailing Address - Fax:
Practice Address - Street 1:100 E VIENNA ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1421
Practice Address - Country:US
Practice Address - Phone:810-687-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist