Provider Demographics
NPI:1255671194
Name:DRUGSTORE MAX
Entity Type:Organization
Organization Name:DRUGSTORE MAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAROV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-501-0926
Mailing Address - Street 1:17901 GOVERNORS HWY
Mailing Address - Street 2:100
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1144
Mailing Address - Country:US
Mailing Address - Phone:888-467-9629
Mailing Address - Fax:
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:100
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:888-467-9629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054017498333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy