1679893887 NPI number — SAV-PLUS PHARMACY

Table of content: (NPI 1679893887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679893887 NPI number — SAV-PLUS PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAV-PLUS PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAV-PLUS PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679893887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
775 BALDWIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48340-2576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-481-9299
Provider Business Mailing Address Fax Number:
248-481-9297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
775 BALDWIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48340-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-481-9299
Provider Business Practice Location Address Fax Number:
248-481-9297
Provider Enumeration Date:
06/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZAWAIDEH
Authorized Official First Name:
ALEXANDRIA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
248-877-0121

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301009372 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2125603 . This is a "PK" identifier . This identifiers is of the category "OTHER".