Provider Demographics
NPI:1093972242
Name:SAVKUB, MICHAEL (RPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SAVKUB
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BRIGHTON 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5375
Mailing Address - Country:US
Mailing Address - Phone:718-934-0022
Mailing Address - Fax:718-934-1383
Practice Address - Street 1:124 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5375
Practice Address - Country:US
Practice Address - Phone:718-934-0022
Practice Address - Fax:718-934-1383
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068582Medicaid