Provider Demographics
NPI:1104157635
Name:SANDERS, CLINTON CHRISTOPHER (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:CHRISTOPHER
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 S NOGALES HWY
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-5284
Mailing Address - Country:US
Mailing Address - Phone:520-780-8146
Mailing Address - Fax:520-204-1092
Practice Address - Street 1:18600 S NOGALES HWY
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5284
Practice Address - Country:US
Practice Address - Phone:520-780-8146
Practice Address - Fax:520-204-1092
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist