Sanders, Jack Larry

Sanders, Jack Larry is an sole proprietor health care provider with primary practice located at 3160 Audubon Dr , Laurel MS 39440. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Sanders, Jack Larry can be contacted via phone (601) 428-0688.

Contact Information

Primary practice address
3160 Audubon Dr Laurel MS 39440
Fax: (601) 428-0689
Website:

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X E-06744 Mississippi

Profile Details

NPI number 1619050150
LBN Legal business name Sanders, Jack Larry
Credentials R PH
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 20th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619050150 NPPES
Mississippi Other E-06744 STATE LICENSE NUMBER

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