Provider Demographics
NPI:1558689737
Name:NEWPORT SAV-MOR
Entity Type:Organization
Organization Name:NEWPORT SAV-MOR
Other - Org Name:NEWPORT SAV-MOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEYNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-586-7501
Mailing Address - Street 1:7505 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-8908
Mailing Address - Country:US
Mailing Address - Phone:734-586-7501
Mailing Address - Fax:734-586-7573
Practice Address - Street 1:7505 GRAFTON RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-8908
Practice Address - Country:US
Practice Address - Phone:734-586-7501
Practice Address - Fax:734-586-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
MI53010093433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2373986OtherNCPDP PROVIDER IDENTIFICATION NUMBER