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General NPI Number Information
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NPI Number | 1992976211
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Entity Type | Organization
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Legal Business Name | DRUGSTORE MAX LLC
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 9228 INDIANAPOLIS BLVD 7C
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City | HIGHLAND
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State | IN
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Zip | 46322-2558
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Country | US
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Telephone | 219-595-0437
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Fax | 219-595-0169
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Provider Business Mailing Address
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Address Line | 9228 INDIANAPOLIS BLVD 7C
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City | HIGHLAND
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State | IN
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Zip | 46322-2558
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Country | US
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Telephone | 219-595-0437
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Fax | 219-595-0169
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Authorized Official
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Title or Position | CEO
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Name | TALITHA BANGALAN
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054016432
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License Number State | IN
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