Provider Demographics
NPI:1326399627
Name:SERVATIUS, ALEX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:SERVATIUS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N STORYBOOK WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4891
Mailing Address - Country:US
Mailing Address - Phone:208-724-4244
Mailing Address - Fax:
Practice Address - Street 1:217 N STORYBOOK WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4891
Practice Address - Country:US
Practice Address - Phone:208-724-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist