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
2201 W SLAKE BLVD, SOUTHLAKE, TX 76092
(817) 421-3430
(817) 251-1167
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
16217
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4592855
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
463736
—
TX
Enumeration date
06/02/2006
Last updated
12/06/2010
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