Individual
BRYAN ANDRE SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH.
Contact information
Practice address
327 MAIN, ANTONITO, CO 81120
(719) 376-5450
Mailing address
2801 PARK AVE, ALAMOSA, CO 81101-2089
(719) 587-3885
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
11224
NV
183500000X
Pharmacist
Primary
16713
CO
Other
Enumeration date
10/02/2008
Last updated
10/02/2008
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