MEDICARE: DR. CHARLES DORRANCE SANDS III PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	12573	AL

General Provider Information

NPI Number	:	1174512040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DORRANCE SANDS III PHARM.D.

Provider Business Mailing Address
First Line	:	3414 LOCH RIDGE TRL
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35216-4406
Country	:	US
Telephone Number	:	205-822-7882
Fax Number	:	205-726-2669

Provider Business Practice Location Address
First Line	:	800 LAKESHORE DR
Second Line	:	SAMFORD UNIVERSITY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35229-0001
Country	:	US
Telephone Number	:	205-726-2914
Fax Number	:	205-726-2669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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