Provider Demographics
NPI:1083005730
Name:SASSER, WENDELL
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:
Last Name:SASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S TALLAHASSEE ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-6415
Mailing Address - Country:US
Mailing Address - Phone:912-375-3575
Mailing Address - Fax:912-375-3590
Practice Address - Street 1:112 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6415
Practice Address - Country:US
Practice Address - Phone:912-375-3575
Practice Address - Fax:912-375-3590
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist