Organization
ALBERTSONS LLC
Active
Other names
SAVON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAN JOHNSON (MANAGER MANAGED HEALTHCARE)
(208) 395-3436
Entity
Organization
Contact information
Practice address
615 UNIVERSITY DR E, COLLEGE STATION, TX 77840-1803
(979) 260-4204
(979) 260-1616
Mailing address
3030 CULLERTON ST, FRANKLIN PARK, IL 60131-2205
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
14822
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4503430
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
464117
—
TX
Enumeration date
06/02/2006
Last updated
12/03/2010
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