Provider Demographics
NPI:1063731495
Name:SANFORD, ALAN GREGORY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:GREGORY
Last Name:SANFORD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13167 BLACK MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2684
Mailing Address - Country:US
Mailing Address - Phone:858-484-2851
Mailing Address - Fax:
Practice Address - Street 1:13167 BLACK MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2684
Practice Address - Country:US
Practice Address - Phone:858-484-2851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41085OtherCA PHARMACIST LICENSE #