MEDICARE: NAI SATURN EASTERN LLC

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	0201003956	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2150047	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083650683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAI SATURN EASTERN LLC

Provider Business Mailing Address
First Line	:	250 E PARKCENTER BLVD
Second Line	:	MAILSTOP SEC2-B
City	:	BOISE
State	:	ID
Zip	:	83706-3940
Country	:	US
Telephone Number	:	847-916-4463
Fax Number	:	847-916-4736

Provider Business Practice Location Address
First Line	:	12821 BRAEMAR VILLAGE PLZ
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-5502
Country	:	US
Telephone Number	:	703-257-0436
Fax Number	:	703-257-4642

Authorized Official
Title or Position	:	ASSISTANT MANAGER, ENROLLMENTS
Name	:	TIFFANY ELIOPULOS
Credential	:
Telephone Number	:	208-395-3906

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	09/27/2018

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Directions to “NAI SATURN EASTERN LLC ” Practice Location

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