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
12031 SOUTHERN BLVD, LOXAHATCHEE, FL 33470-4994
(561) 793-2248
(561) 793-2977
Mailing address
75 REMITTANCE DR, SUITE 1119, CHICAGO, IL 60675-1119
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH17895
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031530300
—
FL
01
—
1092511
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
06/02/2006
Last updated
01/11/2010
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