Provider Demographics
NPI:1962448415
Name:SABOURINS PHARMACY INC
Entity Type:Organization
Organization Name:SABOURINS PHARMACY INC
Other - Org Name:SABOURINS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPARLAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:989-667-4877
Mailing Address - Street 1:1461 S HURON RD
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9496
Mailing Address - Country:US
Mailing Address - Phone:989-667-4877
Mailing Address - Fax:989-671-0698
Practice Address - Street 1:1461 S HURON RD
Practice Address - Street 2:
Practice Address - City:KAWKAWLIN
Practice Address - State:MI
Practice Address - Zip Code:48631-9496
Practice Address - Country:US
Practice Address - Phone:989-667-4877
Practice Address - Fax:989-671-0698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010072363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2331952Medicaid
2043101OtherPK