Provider Demographics
NPI:1972085793
Name:SAVALIA, KOMALBEN V
Entity Type:Individual
Prefix:
First Name:KOMALBEN
Middle Name:V
Last Name:SAVALIA
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 1:2223 DODGE ST APT 1002
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1962
Mailing Address - Country:US
Mailing Address - Phone:570-561-4064
Mailing Address - Fax:
Practice Address - Street 1:6304 N 99TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1528
Practice Address - Country:US
Practice Address - Phone:402-492-9349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist