Provider Demographics
NPI:1538210414
Name:DRUG MAX INC
Entity type:Organization
Organization Name:DRUG MAX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-584-4600
Mailing Address - Street 1:5472 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3223
Mailing Address - Country:US
Mailing Address - Phone:323-584-4600
Mailing Address - Fax:313-584-3784
Practice Address - Street 1:5472 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3223
Practice Address - Country:US
Practice Address - Phone:323-584-4600
Practice Address - Fax:313-584-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010059613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI874668035Medicaid
MI2352209OtherNCPDP
MI540H223660OtherBCBSM DME
MI2352209OtherNCPDP