Provider Demographics
NPI:1467631481
Name:PHANEKHAM, SAVIVAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SAVIVAN
Middle Name:
Last Name:PHANEKHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 QUARTZ LOOP
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2636
Mailing Address - Country:US
Mailing Address - Phone:303-216-1503
Mailing Address - Fax:
Practice Address - Street 1:557 BURBANK ST
Practice Address - Street 2:SUITE Q
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7160
Practice Address - Country:US
Practice Address - Phone:303-460-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist