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General NPI Number Information
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NPI Number | 1265032510
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Entity Type | Individual
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Provider Name | MRS. SANDRA LEE FUNDERBURK
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 3401 S 31ST ST
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City | TEMPLE
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State | TX
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Zip | 76502-1902
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Country | US
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Telephone | 254-778-4636
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Fax | 254-778-0578
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Provider Business Mailing Address
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Address Line | 1627 EAGLE BLUFF DR
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City | TROY
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State | TX
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Zip | 76579-3338
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Country | US
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Telephone | 254-718-4518
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Fax | 254-778-0578
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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 | 36345
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License Number State | TX
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