Provider Demographics
NPI:1043505944
Name:SANDSTROM, PAUL ALEX (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALEX
Last Name:SANDSTROM
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 1:5225 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3139
Mailing Address - Country:US
Mailing Address - Phone:419-843-1622
Mailing Address - Fax:
Practice Address - Street 1:5225 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3139
Practice Address - Country:US
Practice Address - Phone:419-843-1622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230604183500000X
MI5302039954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1Medicaid