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NPI Code Detail

MEDICARE: WYNN SANDERS R. PH.

MEDICARE: WYNN SANDERS R. PH.
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
1183500000XPharmacistE5177MS

General Provider Information

NPI Number : 1558496471
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYNN SANDERS R. PH.
Provider Business Mailing Address
First Line : 1977 SUSAN DR
Second Line :
City : GREENVILLE
State : MS
Zip : 38701-7733
Country : US
Telephone Number : 662-332-1376
Fax Number :
Provider Business Practice Location Address
First Line : 1427 S MAIN ST
Second Line :
City : GREENVILLE
State : MS
Zip : 38701-7000
Country : US
Telephone Number : 662-378-2060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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Directions to “ WYNN SANDERS R. PH.” Practice Location

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