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General NPI Number Information
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NPI Number | 1255671194
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Entity Type | Organization
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Legal Business Name | DRUGSTORE MAX
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 02/28/2013
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Provider Practice Location Address
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Address Line | 17901 GOVERNORS HWY 100
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 888-467-9629
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Fax |
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Provider Business Mailing Address
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Address Line | 17901 GOVERNORS HWY 100
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City | HOMEWOOD
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State | IL
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Zip | 60430-1144
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Country | US
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Telephone | 888-467-9629
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. TALITHA AZAROV
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Credential | RPH
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Telephone | 847-501-0926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 054017498
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License Number State | IL
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