Provider Demographics
NPI:1215401500
Name:SANDEFER, FRED III (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:SANDEFER
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:FREDDIE
Other - Middle Name:
Other - Last Name:SANDEFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3331 DELL GLADE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4715
Mailing Address - Country:US
Mailing Address - Phone:901-299-9078
Mailing Address - Fax:
Practice Address - Street 1:4264 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4044
Practice Address - Country:US
Practice Address - Phone:901-763-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist