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General NPI Number Information
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NPI Number | 1114007994
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Entity Type | Individual
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Provider Name | MARSHA MYRICK SANDERS R.PH.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 15 LAKESHORE DR
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City | LAUREL
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State | MS
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Zip | 39443
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Country | US
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Telephone | 601-729-4407
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LAKESHORE DR
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City | LAUREL
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State | MS
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Zip | 39443-7848
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Country | US
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Telephone | 601-729-4407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-06745
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License Number State | MS
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