Provider Demographics
NPI:1366601320
Name:SAV ON HOME HEALTHCARE SUPPLY
Entity type:Organization
Organization Name:SAV ON HOME HEALTHCARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-377-3154
Mailing Address - Street 1:34550 GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1304
Mailing Address - Country:US
Mailing Address - Phone:734-525-1700
Mailing Address - Fax:734-525-1808
Practice Address - Street 1:36567 GODDARD RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1232
Practice Address - Country:US
Practice Address - Phone:734-941-0755
Practice Address - Fax:734-941-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301006646332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4843888OtherNCPDP IDENTIFICATION NUMBER
MI5301006646OtherMICHIGAN PHARMACY LICENSE
MI4843888Medicaid
MI540H219260OtherBLUE CROSS BLUE SHIELD MICHIGAN DME PROVIDER ID
MI5301006646OtherMICHIGAN CONTROLLED SUBSTANCE LICENSE
MI5301006646OtherMICHIGAN CONTROLLED SUBSTANCE LICENSE
MI4843888Medicaid