Provider Demographics
NPI:1063043750
Name:FAIRWAY DRUGS INC
Entity Type:Organization
Organization Name:FAIRWAY DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RHEAUME
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:586-771-0030
Mailing Address - Street 1:19332 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-1495
Mailing Address - Country:US
Mailing Address - Phone:586-771-0030
Mailing Address - Fax:
Practice Address - Street 1:19332 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1495
Practice Address - Country:US
Practice Address - Phone:586-771-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRWAY DRUGS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy