MEDICARE: MR. SANDRA EILEEN ANDERSON RPH

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	PS0028566	FL

General Provider Information

NPI Number	:	1376823856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANDRA EILEEN ANDERSON RPH

Provider Business Mailing Address
First Line	:	13130 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2406
Country	:	US
Telephone Number	:	813-962-4983
Fax Number	:	813-265-4406

Provider Business Practice Location Address
First Line	:	13130 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2406
Country	:	US
Telephone Number	:	813-962-4983
Fax Number	:	813-265-4406

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

Provider Enumeration Date	:	08/28/2011
Last Update Date	:	08/28/2011

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