MEDICARE: HEALTH SAVER RX, 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	13147	NC

General Provider Information

NPI Number	:	1316483472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH SAVER RX, LLC

Provider Business Mailing Address
First Line	:	3809 BEAM ROAD SUITE H
Second Line	:	SUITE H
City	:	CHARLOTTE
State	:	NC
Zip	:	28217
Country	:	US
Telephone Number	:	704-307-4580
Fax Number	:	704-631-9522

Provider Business Practice Location Address
First Line	:	3809 BEAM ROAD SUITE H
Second Line	:	SUITE H
City	:	CHARLOTTE
State	:	NC
Zip	:	28217
Country	:	US
Telephone Number	:	704-307-4580
Fax Number	:	704-631-9522

Authorized Official
Title or Position	:	PIC/AUTHORIZED SIGNATORY
Name	:	JELANI DAVIS
Credential	:
Telephone Number	:	704-307-4580

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/13/2017

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