Provider Demographics
NPI:1083873046
Name:SAV ON HOME HEALTHCARE SUPPLY INC
Entity Type:Organization
Organization Name:SAV ON HOME HEALTHCARE SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT - PHARMACY OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-377-3154
Mailing Address - Street 1:21120 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4032
Mailing Address - Country:US
Mailing Address - Phone:248-357-4550
Mailing Address - Fax:248-357-2332
Practice Address - Street 1:8900 MACOMB ST
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-1577
Practice Address - Country:US
Practice Address - Phone:734-676-6000
Practice Address - Fax:734-676-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MI53010061033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4838940Medicaid
MI540H219260OtherMICHIGAN BLUE CROSS BLUE SHIELD DME PROVIDER
MI2353441OtherNCPDP IDENTIFICATION NUMBER
MI5301006103OtherMICHIGAN PHARMACY LICENSE
MI5301006103OtherMICHIGAN PHARMACY LICENSE
MI540H219260OtherMICHIGAN BLUE CROSS BLUE SHIELD DME PROVIDER