Provider Demographics
NPI:1760763320
Name:SCRIVANO, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SCRIVANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 NEW HOME RD
Mailing Address - Street 2:
Mailing Address - City:STONEFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62987-1470
Mailing Address - Country:US
Mailing Address - Phone:618-713-5766
Mailing Address - Fax:
Practice Address - Street 1:110 W 10TH ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1502
Practice Address - Country:US
Practice Address - Phone:618-534-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist