Provider Demographics
NPI:1497388904
Name:SANDERS, BEN ALLEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:ALLEN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 BETHELVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6859
Mailing Address - Country:US
Mailing Address - Phone:678-456-4054
Mailing Address - Fax:678-456-4058
Practice Address - Street 1:KROGER PHARMACY 627
Practice Address - Street 2:5550 BETHELVIEW ROAD
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:678-456-4054
Practice Address - Fax:678-456-4058
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH163481835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist