Provider Demographics
NPI:1316066244
Name:SANDERS, JILL (RPH)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 WILSON PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1812
Mailing Address - Country:US
Mailing Address - Phone:505-256-5184
Mailing Address - Fax:
Practice Address - Street 1:125 BIA ROUTE
Practice Address - Street 2:PINE HILL HEALTH CENTER
Practice Address - City:PINE HILL
Practice Address - State:NM
Practice Address - Zip Code:87357
Practice Address - Country:US
Practice Address - Phone:505-775-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000052721835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy