Provider Demographics
NPI:1033117536
Name:SANDBERG, ALVIN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:M
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 FLAGSTONE DR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5199
Mailing Address - Country:US
Mailing Address - Phone:423-473-0225
Mailing Address - Fax:
Practice Address - Street 1:240 FLAGSTONE DR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-5199
Practice Address - Country:US
Practice Address - Phone:423-473-0225
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78681835P1200X
GARPH0189091835P1200X
VT00017971835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy