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
1	333600000X	Pharmacy	5301007900	MI
2	3336C0003X	Community/Retail Pharmacy	5301007900	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4821915	OTHER	MI	MI-DME
2	1477653707	OTHER	MI	NPI
3	2365939	OTHER	MI	NCPDP

General Provider Information

NPI Number	:	1477653707
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	:	602 MITCHELL
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-2510
Country	:	US
Telephone Number	:	231-775-6383
Fax Number	:	231-775-1280

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	01/22/2026

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

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