Provider Demographics
NPI:1043556269
Name:SANDBERG, KURTIS M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:M
Last Name:SANDBERG
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 1:235 S PLEASANTBURG DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2521
Mailing Address - Country:US
Mailing Address - Phone:864-250-4709
Mailing Address - Fax:
Practice Address - Street 1:235 S PLEASANTBURG DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2521
Practice Address - Country:US
Practice Address - Phone:864-250-4709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13295183500000X
PARP444879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist