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General NPI Number Information
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NPI Number | 1629416938
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Entity Type | Individual
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Provider Name | LARRY D SANDERS RPH
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Gender | Male
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Dates
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Enumeration Date | 06/08/2013
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Last Update Date | 06/08/2013
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Provider Practice Location Address
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Address Line | 3076 TOM TOM DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-8630
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Country | US
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Telephone | 618-322-3483
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Fax |
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Provider Business Mailing Address
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Address Line | 3076 TOM TOM DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-8630
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Country | US
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Telephone | 618-322-3483
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | S017258
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 051.028931
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 17666
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License Number State | NV
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