Provider Demographics
NPI:1962427401
Name:SANDISON, THOMAS LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEE
Last Name:SANDISON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12955 ROBINS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-8974
Mailing Address - Country:US
Mailing Address - Phone:231-547-5280
Mailing Address - Fax:231-536-7739
Practice Address - Street 1:1250 LEARS RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9252
Practice Address - Country:US
Practice Address - Phone:231-242-1667
Practice Address - Fax:231-242-1667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist