Provider Demographics
NPI:1255606141
Name:PODLISKA, SAVANNAH LEE (CPHT)
Entity type:Individual
Prefix:MISS
First Name:SAVANNAH
Middle Name:LEE
Last Name:PODLISKA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2212
Mailing Address - Country:US
Mailing Address - Phone:541-523-0607
Mailing Address - Fax:541-523-0589
Practice Address - Street 1:700 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2212
Practice Address - Country:US
Practice Address - Phone:541-523-0607
Practice Address - Fax:541-523-0589
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0006409183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCPT-0006409OtherSTATE PHARMACIST LICENSE