Individual
EDNA V SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
2709 PAN AM FWY NE STE G, ALBUQUERQUE, NM 87107-1650
(505) 344-4739
Mailing address
PO BOX 16084, SANTA FE, NM 87592-6084
(505) 471-3021
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4883
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4883
PHARMACY LICENSE--NM #4883
NM
Enumeration date
09/24/2010
Last updated
09/24/2010
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