Healthcare Provider Details

I. General information

NPI: 1912849191
Provider Name (Legal Business Name): STEPHEN SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N GRAPEVINE RD
SPRINGFIELD MO
65802-6283
US

IV. Provider business mailing address

830 N GRAPEVINE RD
SPRINGFIELD MO
65802-6283
US

V. Phone/Fax

Practice location:
  • Phone: 417-597-4297
  • Fax:
Mailing address:
  • Phone: 417-597-4297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2018025517
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: