Healthcare Provider Details

I. General information

NPI: 1215570932
Provider Name (Legal Business Name): WAYNE RX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4603 WAYNE RD
WAYNE MI
48184
US

IV. Provider business mailing address

4603 WAYNE RD
WAYNE MI
48184
US

V. Phone/Fax

Practice location:
  • Phone: 313-888-5888
  • Fax:
Mailing address:
  • Phone: 313-888-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HAIDAR
Title or Position: OWNER
Credential:
Phone: 313-888-5888