Provider Demographics
NPI:1023316171
Name:FAULKNER, SANDRA JEAN (DPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MCMURRY BLVD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1115
Mailing Address - Country:US
Mailing Address - Phone:615-374-2438
Mailing Address - Fax:615-374-3027
Practice Address - Street 1:210 MCMURRY BLVD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1115
Practice Address - Country:US
Practice Address - Phone:615-374-2438
Practice Address - Fax:615-374-3027
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2011-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-6292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist