MEDICARE: DRUG MAX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301005961	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2352209	OTHER	MI	NCPDP
3	540H223660	OTHER	MI	BCBSM DME

General Provider Information

NPI Number	:	1538210414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRUG MAX INC

Provider Business Mailing Address
First Line	:	5472 SCHAEFER RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3223
Country	:	US
Telephone Number	:	323-584-4600
Fax Number	:	313-584-3784

Provider Business Practice Location Address
First Line	:	5472 SCHAEFER RD
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-3223
Country	:	US
Telephone Number	:	323-584-4600
Fax Number	:	313-584-3784

Authorized Official
Title or Position	:	OWNER
Name	:	LEILA FAWAZ
Credential	:	PHARMD
Telephone Number	:	313-584-4600

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/07/2015

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