Provider Demographics
NPI:1972251619
Name:SANDOVAL, ASHLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SANDOVAL
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-0159
Mailing Address - Country:US
Mailing Address - Phone:541-536-1111
Mailing Address - Fax:541-536-1980
Practice Address - Street 1:51600 HUNTINGTON RD STE A
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-8887
Practice Address - Country:US
Practice Address - Phone:541-536-1111
Practice Address - Fax:541-536-1980
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0018702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist