Provider Demographics
NPI:1164565024
Name:SAVCO GENERIC DRUGS INC
Entity Type:Organization
Organization Name:SAVCO GENERIC DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUCCINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:408-298-6664
Mailing Address - Street 1:2101 FOREST AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1424
Mailing Address - Country:US
Mailing Address - Phone:408-298-6664
Mailing Address - Fax:408-298-4150
Practice Address - Street 1:2101 FOREST AVE STE 122
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1424
Practice Address - Country:US
Practice Address - Phone:408-298-6664
Practice Address - Fax:408-298-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHA325060332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA325060Medicaid
0292460002Medicare NSC