Provider Demographics
NPI:1417042268
Name:SANDER PHARMACY OF WESLACO, INC.
Entity Type:Organization
Organization Name:SANDER PHARMACY OF WESLACO, INC.
Other - Org Name:SANDER PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-968-4528
Mailing Address - Street 1:916 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6414
Mailing Address - Country:US
Mailing Address - Phone:956-968-4528
Mailing Address - Fax:956-968-8254
Practice Address - Street 1:916 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6414
Practice Address - Country:US
Practice Address - Phone:956-968-4528
Practice Address - Fax:956-968-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
TX062983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX148344Medicaid
TX108446902Medicaid
TX108446901Medicaid
TX142243Medicaid
TX108446902Medicaid