Provider Demographics
NPI:1124025432
Name:SANDERS PHARMACEUTICALS INC
Entity Type:Organization
Organization Name:SANDERS PHARMACEUTICALS INC
Other - Org Name:RANCHO PARK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHTESADI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:310-475-3541
Mailing Address - Street 1:9711 CASHIO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2805
Mailing Address - Country:US
Mailing Address - Phone:310-475-3541
Mailing Address - Fax:310-474-3323
Practice Address - Street 1:10587 W PICO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2333
Practice Address - Country:US
Practice Address - Phone:310-475-3541
Practice Address - Fax:310-474-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50485333600000X, 3336C0003X
CAPHY 504853336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0512295OtherNCPDP NUMBER
CAPHY 50485OtherBOARD OF PHARMACY PERMIT