Provider Demographics
NPI:1396143103
Name:SAV-ON PHARMACY, LLC.
Entity type:Organization
Organization Name:SAV-ON PHARMACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-4179
Mailing Address - Street 1:1610 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7301
Mailing Address - Country:US
Mailing Address - Phone:870-793-4770
Mailing Address - Fax:870-698-0095
Practice Address - Street 1:1610 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7301
Practice Address - Country:US
Practice Address - Phone:870-793-4770
Practice Address - Fax:870-698-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR12611333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206788407Medicaid
2149253OtherPK
AR206788407Medicaid