MEDICARE: CONSUMER SAVING ADVANTAGE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	27431	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2130123	OTHER		PK

General Provider Information

NPI Number	:	1063711364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSUMER SAVING ADVANTAGE PHARMACY INC

Provider Business Mailing Address
First Line	:	7209 NORTHERN LIGHTS CT
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-8990
Country	:	US
Telephone Number	:	281-250-4134
Fax Number	:

Provider Business Practice Location Address
First Line	:	10235 LAKE JUNE RD STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-3376
Country	:	US
Telephone Number	:	214-628-7206
Fax Number	:	214-628-7207

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	ISAAC BOGONKO
Credential	:
Telephone Number	:	281-250-4134

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	08/14/2013

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