Basic Information
Provider Information
NPI: 1053854950
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAVIO
FirstName: ASHLEY
MiddleName: BROOKE
NamePrefix:  
NameSuffix:  
Credential: PHARMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2700 DOLBEER ST
Address2:  
City: EUREKA
State: CA
PostalCode: 955014736
CountryCode: US
TelephoneNumber: 7074458121
FaxNumber: 7072693731
Practice Location
Address1: 2700 DOLBEER ST
Address2:  
City: EUREKA
State: CA
PostalCode: 955014736
CountryCode: US
TelephoneNumber: 7074458121
FaxNumber: 7072693731
Other Information
ProviderEnumerationDate: 11/24/2016
LastUpdateDate: 11/24/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X75417CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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