Healthcare Provider Details

I. General information

NPI: 1174512040
Provider Name (Legal Business Name): CHARLES DORRANCE SANDS III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DR SAMFORD UNIVERSITY
BIRMINGHAM AL
35229-0001
US

IV. Provider business mailing address

3414 LOCH RIDGE TRL
HOOVER AL
35216-4406
US

V. Phone/Fax

Practice location:
  • Phone: 205-726-2914
  • Fax: 205-726-2669
Mailing address:
  • Phone: 205-822-7882
  • Fax: 205-726-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12573
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: