Healthcare Provider Details

I. General information

NPI: 1568052744
Provider Name (Legal Business Name): CRYSTAL DANIELLE SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 19TH ST S
BIRMINGHAM AL
35233-1927
US

IV. Provider business mailing address

5800 MCWAINE DR
BESSEMER AL
35022-7515
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax:
Mailing address:
  • Phone: 205-565-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: