Basic Information
Provider Information
NPI: 1093261786
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHELDON
FirstName: CASSANDRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5001 N. PIEDRAS
Address2: PHARMACY DEPARTMENT
City: EL PASO
State: TX
PostalCode: 79930
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 5001 N. PIEDRAS
Address2: PHARMACY DEPARTMENT
City: EL PASO
State: TX
PostalCode: 79930
CountryCode: US
TelephoneNumber: 9155646100
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/01/2016
LastUpdateDate: 09/29/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X58585TXN Pharmacy Service ProvidersPharmacist 
1835P0018X58585TXY Pharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

No ID Information.


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