Provider Demographics
NPI:1023002961
Name:SANDERS, MICHAEL WOLLMAN I (PHARMD, CGP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WOLLMAN
Last Name:SANDERS
Suffix:I
Gender:M
Credentials:PHARMD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ALDERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4602
Mailing Address - Country:US
Mailing Address - Phone:707-545-0742
Mailing Address - Fax:707-545-0742
Practice Address - Street 1:128 ALDERBROOK DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4602
Practice Address - Country:US
Practice Address - Phone:707-545-0742
Practice Address - Fax:707-545-0742
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 279561835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy