Healthcare Provider Details

I. General information

NPI: 1174723852
Provider Name (Legal Business Name): CARMEN R SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FORT STREET
NEAH BAY WA
98357-0410
US

IV. Provider business mailing address

PO BOX 410
NEAH BAY WA
98357-0410
US

V. Phone/Fax

Practice location:
  • Phone: 360-645-2233
  • Fax:
Mailing address:
  • Phone: 360-645-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00067318
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: