Healthcare Provider Details

I. General information

NPI: 1508075904
Provider Name (Legal Business Name): TERA CHRISTINE SANDERS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 W JACKSON ST
OZARK MO
65721-9164
US

IV. Provider business mailing address

3056 S PALISADES DR
SPRINGFIELD MO
65807-8640
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-4335
  • Fax: 417-581-5660
Mailing address:
  • Phone: 417-459-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005021398
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: