Provider Demographics
NPI:1316290661
Name:SANDERS, LONNIE HILTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:HILTON
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S, INTERNATIONAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1615
Mailing Address - Country:US
Mailing Address - Phone:407-805-9148
Mailing Address - Fax:407-805-0126
Practice Address - Street 1:1201 S INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1615
Practice Address - Country:US
Practice Address - Phone:407-805-9148
Practice Address - Fax:407-805-0126
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS22730OtherSTATE LICENSE