Healthcare Provider Details

I. General information

NPI: 1720196199
Provider Name (Legal Business Name): FAIRWAY DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19332 E 10 MILE RD
EASTPOINTE MI
48021-1450
US

IV. Provider business mailing address

43155 W 9 MILE RD
NOVI MI
48375-4190
US

V. Phone/Fax

Practice location:
  • Phone: 586-771-0030
  • Fax: 586-771-2169
Mailing address:
  • Phone: 248-348-1470
  • Fax: 248-348-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301004965
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YVONNE GALLAGHER
Title or Position: VICE-PRESIDENT
Credential:
Phone: 248-348-1570