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NPI Code Detail

MEDICARE: JEFFREY S SANDERS DPH

MEDICARE: JEFFREY S SANDERS DPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist10602OK

General Provider Information

NPI Number : 1881690105
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY S SANDERS DPH
Provider Business Mailing Address
First Line : 22904 E 815 RD
Second Line :
City : WELLING
State : OK
Zip : 74471-2073
Country : US
Telephone Number : 918-458-0928
Fax Number :
Provider Business Practice Location Address
First Line : 301 J T STITES BLVD
Second Line :
City : SALLISAW
State : OK
Zip : 74955-9302
Country : US
Telephone Number : 918-775-9159
Fax Number : 918-775-4778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 07/08/2007

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