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NPI Code Detail

MEDICARE: PREVO'S FAMILY MARKETS LLC

MEDICARE: PREVO'S FAMILY MARKETS 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
13336C0003XCommunity/Retail Pharmacy5301008631MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11033320528OTHERMINPI
22369747OTHERMINCPDP
35192332OTHERMIMI-DME

General Provider Information

NPI Number : 1033320528
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREVO'S FAMILY MARKETS LLC
Provider Business Mailing Address
First Line : 1527 MOMENTUM PL
Second Line : SPARTAN PHARMACY NORTH
City : CHICAGO
State : IL
Zip : 60689-5315
Country : US
Telephone Number : 616-878-8584
Fax Number :
Provider Business Practice Location Address
First Line : 847 S KALAMAZOO ST
Second Line :
City : PAW PAW
State : MI
Zip : 49079-9230
Country : US
Telephone Number : 269-657-1778
Fax Number : 269-657-1779
Authorized Official
Title or Position : DIRECTOR OF PHARMACY
Name : AMY ELLIS
Credential : RPH
Telephone Number : 616-878-2848
Provider Enumeration Date : 05/25/2007
Last Update Date : 01/22/2026

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Directions to “PREVO'S FAMILY MARKETS LLC ” Practice Location

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