Provider Demographics
NPI:1114007994
Name:SANDERS, MARSHA MYRICK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:MYRICK
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-7848
Mailing Address - Country:US
Mailing Address - Phone:601-729-4407
Mailing Address - Fax:
Practice Address - Street 1:15 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443
Practice Address - Country:US
Practice Address - Phone:601-729-4407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist