Provider Demographics
NPI:1902980105
Name:SAVCO GENERIC PHARMACY
Entity Type:Organization
Organization Name:SAVCO GENERIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
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:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty