Healthcare Provider Details

I. General information

NPI: 1306804133
Provider Name (Legal Business Name): SANDLEBEN PHARMACY, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HARRIET ST
EVANSVILLE IN
47710-2136
US

IV. Provider business mailing address

1000 HARRIET ST
EVANSVILLE IN
47710-2136
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-3555
  • Fax: 812-424-3758
Mailing address:
  • Phone: 812-425-3555
  • Fax: 812-424-3758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number60003925A
License Number StateIN

VIII. Authorized Official

Name: MR. THOMAS C FITE
Title or Position: DIRECTOR OF PHARMACY OPERATIONS
Credential: RPH
Phone: 812-425-3555