Provider Demographics
NPI:1508456187
Name:SANDLIN, FRED COLEMAN III
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:COLEMAN
Last Name:SANDLIN
Suffix:III
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:PO BOX 1360
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-1360
Mailing Address - Country:US
Mailing Address - Phone:205-540-7744
Mailing Address - Fax:
Practice Address - Street 1:797 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-4737
Practice Address - Country:US
Practice Address - Phone:205-921-3193
Practice Address - Fax:205-921-2576
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist