Provider Demographics
NPI:1265845309
Name:SANDERS, KENNETH III (BSPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:SANDERS
Suffix:III
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 ARMORY DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1851
Mailing Address - Country:US
Mailing Address - Phone:757-562-7415
Mailing Address - Fax:
Practice Address - Street 1:1031 ARMORY DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1851
Practice Address - Country:US
Practice Address - Phone:757-562-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202206303OtherVIRGINIA PHARMACIST LICENSE NUMBER