Healthcare Provider Details

I. General information

NPI: 1922243435
Provider Name (Legal Business Name): BEYDOUN DRUG STORES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13821 W 9 MILE RD
OAK PARK MI
48237-2775
US

IV. Provider business mailing address

314 CENTRALIA ST
DEARBORN HTS MI
48127-3740
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-0600
  • Fax: 248-541-0603
Mailing address:
  • Phone: 313-663-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009001
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WISSAM BEYDOUN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 313-663-1050