Provider Demographics
NPI:1942892773
Name:SANDERSON, LORA MICHELE
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MICHELE
Last Name:SANDERSON
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 1:2521 13TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4103
Mailing Address - Country:US
Mailing Address - Phone:407-892-7166
Mailing Address - Fax:407-892-0546
Practice Address - Street 1:2521 13TH ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4103
Practice Address - Country:US
Practice Address - Phone:407-892-7166
Practice Address - Fax:407-892-0546
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist