NPIMap

Organization Active NPI

Eastside Discount Pharmacy

  • Community/Retail Pharmacy
  • Detroit, MI
National Provider Identifier
1861666448
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301008846 Issued in MI
Legal business name
EASTSIDE DISCOUNT PHARMACY
Practice address
14366 Gratiot Ave
Ste 100
Detroit, MI 48205-2307
Phone
(313) 839-2000
Fax
(313) 839-2003
NPI assigned
Apr 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

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

Authorized official

Name
Mahmond Foudous
Title
Pharmacist
Phone
(313) 433-5578

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 5301008846 MI Primary

Addresses

Primary practice location

14366 Gratiot Ave
Ste 100
Detroit, MI 48205-2307

Mailing address

14366 Gratiot Ave
Ste 100
Detroit, MI 48205-2307

Other identifiers 1

IdentifierTypeStateIssuer
2371021OtherOTHER ID NUMBER

Other names 1

  • EASTSIDE DISCOUNT PHARMACY Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1861666448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14366 GRATIOT AVE",
            "address_2": "STE 100",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482052307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14366 GRATIOT AVE",
            "address_2": "STE 100",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482052307",
            "telephone_number": "313-839-2000",
            "fax_number": "313-839-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE DISCOUNT PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "FOUDOUS",
        "authorized_official_first_name": "MAHMOND",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "313-433-5578"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "2371021",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTSIDE DISCOUNT PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.