Healthcare Provider Details

I. General information

NPI: 1033117536
Provider Name (Legal Business Name): ALVIN M. SANDBERG R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 FLAGSTONE DR NE
CLEVELAND TN
37323-5199
US

IV. Provider business mailing address

240 FLAGSTONE DR NE
CLEVELAND TN
37323-5199
US

V. Phone/Fax

Practice location:
  • Phone: 423-473-0225
  • Fax:
Mailing address:
  • Phone: 423-473-0225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number7868
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH018909
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0001797
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: