Provider Demographics
NPI:1528741535
Name:MIDDLESTEAD, SAVANNAH ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ROSE
Last Name:MIDDLESTEAD
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 1:157 WREN DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4610
Mailing Address - Country:US
Mailing Address - Phone:218-966-7220
Mailing Address - Fax:
Practice Address - Street 1:2631 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4846
Practice Address - Country:US
Practice Address - Phone:715-392-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22275-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist