Provider Demographics
NPI:1215742473
Name:SANDERS, KENNY (RPH)
Entity type:Individual
Prefix:
First Name:KENNY
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:KENNETH
Other - Last Name:SANDERS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9301 HIGHWAY 119
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-5366
Mailing Address - Country:US
Mailing Address - Phone:205-664-4584
Mailing Address - Fax:
Practice Address - Street 1:9301 HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-5366
Practice Address - Country:US
Practice Address - Phone:205-664-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist