Provider Demographics
NPI:1336485622
Name:SANDUSKY, JAMES CODY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CODY
Last Name:SANDUSKY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-2346
Mailing Address - Country:US
Mailing Address - Phone:618-252-3059
Mailing Address - Fax:618-252-3252
Practice Address - Street 1:710 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2346
Practice Address - Country:US
Practice Address - Phone:618-252-3059
Practice Address - Fax:618-252-3252
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist