=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538210414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRUG MAX INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 12/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5472 SCHAEFER RD
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-584-4600
-----------------------------------------------------
Fax | 313-584-3784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5472 SCHAEFER RD
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-584-4600
-----------------------------------------------------
Fax | 313-584-3784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEILA FAWAZ
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 313-584-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301005961
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------