NPIMap

Organization Active NPI

Fairway Drugs Inc

  • Community/Retail Pharmacy
  • Eastpointe, MI
National Provider Identifier
1720196199
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301004965 Issued in MI
Legal business name
FAIRWAY DRUGS INC
Practice address
19332 E 10 Mile Rd
Eastpointe, MI 48021-1450
Phone
(586) 771-0030
Fax
(586) 771-2169
NPI assigned
Aug 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Yvonne Gallagher
Title
Vice-President
Phone
(248) 348-1570

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301004965 MI Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

19332 E 10 Mile Rd
Eastpointe, MI 48021-1450

Mailing address

43155 W 9 Mile Rd
Novi, MI 48375-4190
Phone (248) 348-1470

Other identifiers 4

IdentifierTypeStateIssuer
2344163OtherOTHER ID NUMBER
OP51190OtherMIMASS IMMUNIZATION ROSTER BILLER
2344163MedicaidMI
MI6999OtherMIPHARMACY/DIABETES SELF-MANAGEMENT EDUCATION

Other names 1

  • FAIRWAY DRUGS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080108000761 MI Part B Supplier - Mass Immunization (Roster Biller Only) 5395825947 Practice locations: Eastpointe, MI

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1720196199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43155 W 9 MILE RD",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483754190",
            "telephone_number": "248-348-1470",
            "fax_number": "248-348-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19332 E 10 MILE RD",
            "city": "EASTPOINTE",
            "state": "MI",
            "postal_code": "480211450",
            "telephone_number": "586-771-0030",
            "fax_number": "586-771-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-27",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "GALLAGHER",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "248-348-1570"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301004965",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2344163",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASS IMMUNIZATION ROSTER BILLER",
            "identifier": "OP51190",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2344163",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY/DIABETES SELF-MANAGEMENT EDUCATION",
            "identifier": "MI6999",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAIRWAY DRUGS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAIRWAY DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eastpointe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.