Provider Demographics
NPI:1811268071
Name:SANDER, ALISA IDA ZEVLEVER (PHARMD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:IDA ZEVLEVER
Last Name:SANDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12708 COEUR DU MONDE CT APT J
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-1544
Mailing Address - Country:US
Mailing Address - Phone:636-579-9955
Mailing Address - Fax:
Practice Address - Street 1:106 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:ELSBERRY
Practice Address - State:MO
Practice Address - Zip Code:63343-1345
Practice Address - Country:US
Practice Address - Phone:573-898-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist