Provider Demographics
NPI:1841286499
Name:SANDERS, MICHAEL SHAWN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:SANDERS
Suffix:
Gender:M
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:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-0206
Mailing Address - Country:US
Mailing Address - Phone:918-256-4849
Mailing Address - Fax:918-256-4594
Practice Address - Street 1:27371 S 4410 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7953
Practice Address - Country:US
Practice Address - Phone:918-256-4849
Practice Address - Fax:918-256-4594
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist