Healthcare Provider Details

I. General information

NPI: 1427952720
Provider Name (Legal Business Name): GREAT LAKES DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13424 DIX TOLEDO RD
SOUTHGATE MI
48195-1852
US

IV. Provider business mailing address

13424 DIX TOLEDO RD
SOUTHGATE MI
48195-1852
US

V. Phone/Fax

Practice location:
  • Phone: 313-378-1938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOHAMED ALI BEYDOUN
Title or Position: OWNER
Credential: PHARMD
Phone: 313-378-1938