Healthcare Provider Details

I. General information

NPI: 1265830996
Provider Name (Legal Business Name): SASHA FLINCHUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4644 HIGHWAY 15 WEST
CLAY CITY KY
40312
US

IV. Provider business mailing address

PO BOX 610
CLAY CITY KY
40312-0610
US

V. Phone/Fax

Practice location:
  • Phone: 606-663-3481
  • Fax:
Mailing address:
  • Phone: 606-663-3481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017163
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: