Healthcare Provider Details

I. General information

NPI: 1699001636
Provider Name (Legal Business Name): SANDER'S DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SOUTH MAIN ST.
ALBANY TX
76430-8054
US

IV. Provider business mailing address

PO BOX 3116 104 S. MAIN STREET
ALBANY TX
76430-8054
US

V. Phone/Fax

Practice location:
  • Phone: 325-762-3979
  • Fax: 325-762-3982
Mailing address:
  • Phone: 325-762-3979
  • Fax: 325-762-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. JOSHUA MATTHEW YARGER
Title or Position: PRESIDENT
Credential: CPHT
Phone: 325-762-3979