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NPI Code Detail

MEDICARE: LARRY D SANDERS RPH

MEDICARE:   LARRY D SANDERS  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
11835P1200XPharmacotherapy PharmacistS017258AZ
21835P1200XPharmacotherapy Pharmacist051.028931IL
31835P1200XPharmacotherapy Pharmacist17666NV

General Provider Information

NPI Number : 1629416938
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY D SANDERS RPH
Provider Business Mailing Address
First Line : 3076 TOM TOM DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-8630
Country : US
Telephone Number : 618-322-3483
Fax Number :
Provider Business Practice Location Address
First Line : 3076 TOM TOM DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-8630
Country : US
Telephone Number : 618-322-3483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2013
Last Update Date : 06/08/2013

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