Provider Demographics
NPI:1710104815
Name:SAVEWAY DISCOUNT STORES OF BROOMALL PA INC
Entity Type:Organization
Organization Name:SAVEWAY DISCOUNT STORES OF BROOMALL PA INC
Other - Org Name:MELS DRUG WORLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-356-6772
Mailing Address - Street 1:2070 SPROUL RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2725
Mailing Address - Country:US
Mailing Address - Phone:610-356-6772
Mailing Address - Fax:610-356-9465
Practice Address - Street 1:2070 SPROUL RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2725
Practice Address - Country:US
Practice Address - Phone:610-356-6772
Practice Address - Fax:610-356-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP413592L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3913262OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0740880001Medicare NSC