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General NPI Number Information
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NPI Number | 1710060207
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Entity Type | Organization
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Legal Business Name | SANDERS PHARMACY NO.5
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1907 NORTH MEDICAL PARK DRIVE
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City | GREENVILLE
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State | MS
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Zip | 38701
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Country | US
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Telephone | 662-378-4138
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 NORTH MEDICAL PARK DRIVE
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City | GREENVILLE
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State | MS
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Zip | 38701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WYNN SANDERS
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Credential |
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Telephone | 66223784138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 485801SG
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License Number State | MS
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