MEDICARE: SANFORD CHEMISTS, 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1558918243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANFORD CHEMISTS, INC.

Provider Business Mailing Address
First Line	:	100 PARK AVE
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PARK AVE
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4027
Country	:	US
Telephone Number	:	919-776-9715
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAVIKUMAR SOMEPALLI
Credential	:
Telephone Number	:	919-776-9715

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	05/12/2020

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