MEDICARE: J A SANDER 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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3654161	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1215042254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J A SANDER INC

Provider Business Mailing Address
First Line	:	1100 N LINDBERGH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 MAPLE AVE
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-2025
Country	:	US
Telephone Number	:	740-455-2020
Fax Number	:	740-455-3878

Authorized Official
Title or Position	:	MEDICAID MEDICARE BILLING SPEC
Name	:	SUSAN GUINN
Credential	:
Telephone Number	:	314-993-6000

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	09/11/2025

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Directions to “J A SANDER INC ” Practice Location

Language	Start Address	Practice Location

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