Healthcare Provider Details

I. General information

NPI: 1023002961
Provider Name (Legal Business Name): MICHAEL WOLLMAN SANDERS I PHARM.D., C.G.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 ALDERBROOK DR
SANTA ROSA CA
95405-4602
US

IV. Provider business mailing address

128 ALDERBROOK DR
SANTA ROSA CA
95405-4602
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-0742
  • Fax: 707-545-0742
Mailing address:
  • Phone: 707-545-0742
  • Fax: 707-545-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH 27956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: