Provider Demographics
NPI:1902086424
Name:SANDERS, CHARLES RAY III (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:SANDERS
Suffix:III
Gender:M
Credentials:PHARMACIST
Other - Prefix:PROF
Other - First Name:CHARLES
Other - Middle Name:RAY
Other - Last Name:SANDERS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:255 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6300
Mailing Address - Country:US
Mailing Address - Phone:864-454-0810
Mailing Address - Fax:864-454-1130
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:EMPLOYEE PAVILION
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10855OtherSC LICENSE