Provider Demographics
NPI:1740518067
Name:SANDERS, MARANDA KAYE (PHARM D)
Entity type:Individual
Prefix:MS
First Name:MARANDA
Middle Name:KAYE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 SANDERS LN
Mailing Address - Street 2:
Mailing Address - City:TILLAR
Mailing Address - State:AR
Mailing Address - Zip Code:71670-9318
Mailing Address - Country:US
Mailing Address - Phone:870-644-3841
Mailing Address - Fax:
Practice Address - Street 1:1626 S MADISON ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3003
Practice Address - Country:US
Practice Address - Phone:870-946-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11205183500000X
TN26672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist