Provider Demographics
NPI:1871920025
Name:SANDERS, LONNIE D (RPH)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-9334
Mailing Address - Country:US
Mailing Address - Phone:541-391-8321
Mailing Address - Fax:541-391-8381
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9334
Practice Address - Country:US
Practice Address - Phone:541-391-8321
Practice Address - Fax:541-391-8381
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00072771835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist