Provider Demographics
NPI:1568084838
Name:BRESHEARS, ANASTASIA MARIE (CPHT)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:MARIE
Last Name:BRESHEARS
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:MARIE
Other - Last Name:CANTERBURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:5020 BOWMAN OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3132
Mailing Address - Country:US
Mailing Address - Phone:916-289-8820
Mailing Address - Fax:
Practice Address - Street 1:4005 MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1770
Practice Address - Country:US
Practice Address - Phone:916-483-2695
Practice Address - Fax:916-483-4158
Is Sole Proprietor?:No
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141705183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician