1386753507 NPI number — DIX DRUGS STORE CORP

Table of content: (NPI 1386753507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386753507 NPI number — DIX DRUGS STORE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIX DRUGS STORE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIX DRUGS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386753507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
655 GOLFCREST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-843-2400
Provider Business Mailing Address Fax Number:
313-843-2402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10066 DIX
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48120-1551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-843-2400
Provider Business Practice Location Address Fax Number:
313-843-2402
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FADLALLAH
Authorized Official First Name:
HASSANE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST AND OWNER
Authorized Official Telephone Number:
313-843-2400

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  5301006503 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 5301006503 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)