MEDICARE: SANDERS PHARMACEUTICALS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PHY50485	CA
2	3336C0004X	Compounding Pharmacy	PHY 50485	CA
3	3336C0003X	Community/Retail Pharmacy	PHY50485	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0512295	OTHER		NCPDP NUMBER
2	PHY 50485	OTHER	CA	BOARD OF PHARMACY PERMIT

General Provider Information

NPI Number	:	1124025432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDERS PHARMACEUTICALS INC

Provider Business Mailing Address
First Line	:	9711 CASHIO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2805
Country	:	US
Telephone Number	:	310-475-3541
Fax Number	:	310-474-3323

Provider Business Practice Location Address
First Line	:	10587 W PICO BLVD
Second Line	:	SUITE A
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2333
Country	:	US
Telephone Number	:	310-475-3541
Fax Number	:	310-474-3323

Authorized Official
Title or Position	:	SECRETARY/PHARMACIST
Name	:	MRS. SHERY EGHTESADI
Credential	:	PHARM D
Telephone Number	:	310-475-3541

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	11/29/2012

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Directions to “SANDERS PHARMACEUTICALS INC ” Practice Location

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