Healthcare Provider Details

I. General information

NPI: 1811268071
Provider Name (Legal Business Name): ALISA IDA ZEVLEVER SANDER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BROADWAY ST STE A
ELSBERRY MO
63343-1345
US

IV. Provider business mailing address

12708 COEUR DU MONDE CT APT J
SAINT LOUIS MO
63146-1544
US

V. Phone/Fax

Practice location:
  • Phone: 573-898-2550
  • Fax:
Mailing address:
  • Phone: 636-579-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2011027367
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: