Provider Demographics
NPI:1154604320
Name:GIFFORD, SASHA MARGO (PHARM D)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:MARGO
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-1959
Mailing Address - Country:US
Mailing Address - Phone:334-285-1450
Mailing Address - Fax:
Practice Address - Street 1:3720 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-1959
Practice Address - Country:US
Practice Address - Phone:334-285-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist