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
4650 SW LOOP 820, FORT WORTH, TX 76109-4429
(817) 738-3491
(817) 732-1485
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
13846
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4582450
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
463243
—
TX
Enumeration date
06/01/2006
Last updated
11/25/2009
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