Provider Demographics
NPI:1154850154
Name:SANDERS, KIMBERLY ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
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 1:548 HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONS GAP
Mailing Address - State:AL
Mailing Address - Zip Code:36861-3163
Mailing Address - Country:US
Mailing Address - Phone:334-406-9542
Mailing Address - Fax:
Practice Address - Street 1:2190 GILMER AVE
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-7123
Practice Address - Country:US
Practice Address - Phone:334-991-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL252290OtherPHARMACY