Provider Demographics
NPI:1760810121
Name:SANDS, KEVIN WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WAYNE
Last Name:SANDS
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 1:1513 N HOWE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2770
Mailing Address - Country:US
Mailing Address - Phone:910-454-9090
Mailing Address - Fax:910-454-9555
Practice Address - Street 1:1513 N HOWE ST STE 8
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2770
Practice Address - Country:US
Practice Address - Phone:910-454-9090
Practice Address - Fax:910-454-9555
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist