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General NPI Number Information
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NPI Number | 1427952720
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Entity Type | Organization
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Legal Business Name | GREAT LAKES DRUGS LLC
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 13424 DIX TOLEDO RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-1852
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Country | US
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Telephone | 313-378-1938
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Fax |
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Provider Business Mailing Address
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Address Line | 13424 DIX TOLEDO RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-1852
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED ALI BEYDOUN
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Credential | PHARMD
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Telephone | 313-378-1938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | NULL
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