Healthcare Provider Details

I. General information

NPI: 1215042254
Provider Name (Legal Business Name): J A SANDER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 MAPLE AVE
ZANESVILLE OH
43701-2025
US

IV. Provider business mailing address

1100 N LINDBERGH BLVD
SAINT LOUIS MO
63132-2914
US

V. Phone/Fax

Practice location:
  • Phone: 740-455-2020
  • Fax: 740-455-3878
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: SUSAN GUINN
Title or Position: MEDICAID MEDICARE BILLING SPEC
Credential:
Phone: 314-993-6000