Provider Demographics
NPI:1629416938
Name:SANDERS, LARRY D (RPH)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:SANDERS
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 1:3076 TOM TOM DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-8630
Mailing Address - Country:US
Mailing Address - Phone:618-322-3483
Mailing Address - Fax:
Practice Address - Street 1:3076 TOM TOM DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-8630
Practice Address - Country:US
Practice Address - Phone:618-322-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0172581835P1200X
IL051.0289311835P1200X
NV176661835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy