Provider Demographics
NPI:1548398589
Name:SANAD, JOHN S (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:SANAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 HOLMES LANDING DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4412
Mailing Address - Country:US
Mailing Address - Phone:904-213-7542
Mailing Address - Fax:
Practice Address - Street 1:1340 HOLMES LANDING DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4412
Practice Address - Country:US
Practice Address - Phone:904-213-7542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37397183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist