Provider Demographics
NPI:1386756377
Name:SAWDEY LLC
Entity type:Organization
Organization Name:SAWDEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-568-3400
Mailing Address - Street 1:126 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:MI
Mailing Address - Zip Code:49245-1046
Mailing Address - Country:US
Mailing Address - Phone:517-568-3400
Mailing Address - Fax:517-568-5608
Practice Address - Street 1:126 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:MI
Practice Address - Zip Code:49245
Practice Address - Country:US
Practice Address - Phone:517-568-3400
Practice Address - Fax:517-568-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010069043336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2040907OtherPK
MI2317279Medicaid
6067380001Medicare NSC
MI2317279Medicare UPIN