1831223544 NPI number — SAV-RX-CHICAGO INC

Table of content: (NPI 1831223544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831223544 NPI number — SAV-RX-CHICAGO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAV-RX-CHICAGO INC
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:
Provider Other Organization Name Type Code:
6
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:
1831223544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 N PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREMONT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68025-4964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-228-3108
Provider Business Mailing Address Fax Number:
888-810-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 S INDIANA AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60605-2857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-957-1718
Provider Business Practice Location Address Fax Number:
312-957-1730
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PITI
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
800-228-2181

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X , with the licence number:  054013862 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1472036 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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