=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396368452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAYLA SAVANT PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2020
-----------------------------------------------------
Last Update Date | 05/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1100 LEJUNE DR
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62703-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-529-6299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 630 BUOY CT
-----------------------------------------------------
City | CHATHAM
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62629-5091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-246-8714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051.299727
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------