Healthcare Provider Details

I. General information

NPI: 1144326760
Provider Name (Legal Business Name): PHILLIP DOUGLAS SANDLIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

831 INSPIRATION WAY
LOUISVILLE KY
40245-3990
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-5913
  • Fax:
Mailing address:
  • Phone: 502-244-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number8924
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: