MEDICARE: SANDRA LASITER

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	183500000X	Pharmacist	12356	AL

General Provider Information

NPI Number	:	1265978159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LASITER

Provider Business Mailing Address
First Line	:	1017 RIVER FALLS ST
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-2532
Country	:	US
Telephone Number	:	334-222-9414
Fax Number	:	334-222-0797

Provider Business Practice Location Address
First Line	:	1017 RIVER FALLS ST
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-2532
Country	:	US
Telephone Number	:	334-222-9414
Fax Number	:	334-222-0797

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

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	01/16/2017

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Directions to “ SANDRA LASITER ” Practice Location

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