MEDICARE: SANDI BANOUR DR

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	RP0014005	WV

General Provider Information

NPI Number	:	1619745130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDI BANOUR DR

Provider Business Mailing Address
First Line	:	300 FAIRMONT AVE
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-2713
Country	:	US
Telephone Number	:	586-770-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 PERRY AVE APT F
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-2774
Country	:	US
Telephone Number	:	586-770-5602
Fax Number	:

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

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	02/12/2024

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Directions to “ SANDI BANOUR DR” Practice Location

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