Healthcare Provider Details

I. General information

NPI: 1942699327
Provider Name (Legal Business Name): SANFORD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2541 S FRENCH AVE
SANFORD FL
32773-5302
US

IV. Provider business mailing address

2541 S FRENCH AVE
SANFORD FL
32773-5302
US

V. Phone/Fax

Practice location:
  • Phone: 407-915-6637
  • Fax: 407-915-6638
Mailing address:
  • Phone: 407-915-6637
  • Fax: 407-915-6638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28835
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH28835
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH28835
License Number StateFL

VIII. Authorized Official

Name: SUNIL PATEL
Title or Position: OWNER / PHARMACIST
Credential: R.PH.
Phone: 407-915-6637