MEDICARE: PREVO'S FAMILY MARKETS, 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	5301008526	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2369038	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1114086113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVO'S FAMILY MARKETS, INC

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	:	3960 44TH ST SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-2420
Country	:	US
Telephone Number	:	616-534-9649
Fax Number	:	616-538-6730

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	AMY ELLIS
Credential	:	RPH
Telephone Number	:	616-878-2848

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	04/21/2026

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Directions to “PREVO'S FAMILY MARKETS, INC ” Practice Location

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