Provider Demographics
NPI:1538382031
Name:SANDSTROM, ANGELA VERDE (RPH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:VERDE
Last Name:SANDSTROM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12177 S 3150 W
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7664
Mailing Address - Country:US
Mailing Address - Phone:801-253-1730
Mailing Address - Fax:
Practice Address - Street 1:5770 S 250 E STE 145
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8138
Practice Address - Country:US
Practice Address - Phone:801-314-2326
Practice Address - Fax:801-314-2143
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1319961701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist