Provider Demographics
NPI:1629862156
Name:SANDOVAL, KIMBERLY KAY (RPH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:SANDOVAL
Suffix:
Gender:X
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7763
Mailing Address - Country:US
Mailing Address - Phone:512-528-7081
Mailing Address - Fax:512-528-7084
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-528-7081
Practice Address - Fax:512-528-7084
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348741835C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835C0205XPharmacy Service ProvidersPharmacistCritical Care