MEDICARE: SAV ON HME HEALTH CRE SPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies	5301006102	MI
2	3336C0003X	Community/Retail Pharmacy	5301006102	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5301006102	OTHER	MI	MICHIGAN PHARMACY LICENSE

General Provider Information

NPI Number	:	1548437585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAV ON HME HEALTH CRE SPLY

Provider Business Mailing Address
First Line	:	21120 BRIDGE ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-4032
Country	:	US
Telephone Number	:	734-377-3154
Fax Number	:	248-357-2332

Provider Business Practice Location Address
First Line	:	5688 N TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3219
Country	:	US
Telephone Number	:	313-565-9357
Fax Number	:	313-565-8457

Authorized Official
Title or Position	:	VICE PRESIDENT PHARMACY OPERATION
Name	:	ANDREW MAC
Credential	:	RPH
Telephone Number	:	734-377-3154

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	03/07/2023

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