Provider Demographics
NPI:1578748273
Name:SAVON MEDICAL PHARMACY, LLC
Entity Type:Organization
Organization Name:SAVON MEDICAL PHARMACY, LLC
Other - Org Name:SAVON MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUHASWA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-879-0087
Mailing Address - Street 1:18000 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2763
Mailing Address - Country:US
Mailing Address - Phone:313-862-8800
Mailing Address - Fax:313-862-8803
Practice Address - Street 1:18000 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2763
Practice Address - Country:US
Practice Address - Phone:313-862-8800
Practice Address - Fax:313-862-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010110063336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043565OtherPK