MEDICARE: NEWPORT SAV-MOR

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	333600000X	Pharmacy
2	3336C0002X	Clinic Pharmacy
3	3336C0003X	Community/Retail Pharmacy	5301009343	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2373986	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1558689737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWPORT SAV-MOR

Provider Business Mailing Address
First Line	:	7505 GRAFTON RD
Second Line	:
City	:	NEWPORT
State	:	MI
Zip	:	48166-8908
Country	:	US
Telephone Number	:	734-586-7501
Fax Number	:	734-586-7573

Provider Business Practice Location Address
First Line	:	7505 GRAFTON RD
Second Line	:
City	:	NEWPORT
State	:	MI
Zip	:	48166-8908
Country	:	US
Telephone Number	:	734-586-7501
Fax Number	:	734-586-7573

Authorized Official
Title or Position	:	OWNER
Name	:	RANDY OLEYNIK
Credential	:
Telephone Number	:	734-586-7501

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	06/30/2010

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Directions to “NEWPORT SAV-MOR ” Practice Location

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