Provider Demographics
NPI:1821397399
Name:SANDERS, NAOMI COCKRELL
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:COCKRELL
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 EASTON CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-6344
Mailing Address - Country:US
Mailing Address - Phone:251-968-6119
Mailing Address - Fax:251-968-2772
Practice Address - Street 1:156 EASTON CIR
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-6344
Practice Address - Country:US
Practice Address - Phone:251-968-6119
Practice Address - Fax:251-968-2772
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL357183500000X
AL9357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist