Provider Demographics
NPI:1902140619
Name:SANDLIN, JIM (RPH)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:SANDLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-9726
Mailing Address - Country:US
Mailing Address - Phone:843-326-5231
Mailing Address - Fax:843-326-5068
Practice Address - Street 1:100 N RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069-9726
Practice Address - Country:US
Practice Address - Phone:843-326-5231
Practice Address - Fax:843-326-5068
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4145OtherSC PHARMACY LISCENSE