Provider Demographics
NPI:1427333418
Name:EINEKE, SANDRA JEAN
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JEAN
Last Name:EINEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 FOREST HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-3207
Mailing Address - Country:US
Mailing Address - Phone:507-317-9486
Mailing Address - Fax:
Practice Address - Street 1:1270 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5228
Practice Address - Country:US
Practice Address - Phone:507-388-1315
Practice Address - Fax:507-388-6369
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist