Basic Information
| Provider Information | |||||||||
| NPI: | 1174512040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | DORRANCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3414 LOCH RIDGE TRL | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352164406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058227882 | ||||||||
| FaxNumber: | 2057262669 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 LAKESHORE DR | ||||||||
| Address2: | SAMFORD UNIVERSITY | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352290001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057262914 | ||||||||
| FaxNumber: | 2057262669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 12573 | AL | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.