Provider Demographics
NPI:1235120460
Name:LANDSBERG, SALLY (RPH)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
Last Name:LANDSBERG
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 1:5700 W THREE FORKS RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-9622
Mailing Address - Country:US
Mailing Address - Phone:914-400-5295
Mailing Address - Fax:
Practice Address - Street 1:5700 W THREE FORKS RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-9622
Practice Address - Country:US
Practice Address - Phone:914-400-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist