Organization
FAIRWAY DRUGS INC
Active
Other names
FAIRWAY DRUGS
Organization subpart
No
Provider details
NPI number
Authorized official
YVONNE GALLAGHER (VICE-PRESIDENT)
(248) 348-1570
Entity
Organization
Contact information
Practice address
19332 E 10 MILE RD, EASTPOINTE, MI 48021-1450
(586) 771-0030
(586) 771-2169
Mailing address
43155 W 9 MILE RD, NOVI, MI 48375-4190
(248) 348-1470
(248) 348-4316
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301004965
MI
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2344163
OTHER ID NUMBER
—
05
—
2344163
—
MI
01
—
MI6999
PHARMACY/DIABETES SELF-MANAGEMENT EDUCATION
MI
01
—
OP51190
MASS IMMUNIZATION ROSTER BILLER
MI
Enumeration date
08/27/2006
Last updated
01/10/2020
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