Provider Demographics
NPI:1588151112
Name:FOX HILLS MEDI-MART DISCOUNT DRUG CENTER INC
Entity type:Organization
Organization Name:FOX HILLS MEDI-MART DISCOUNT DRUG CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-2225
Mailing Address - Street 1:1539 S OPDYKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1042
Mailing Address - Country:US
Mailing Address - Phone:248-858-2225
Mailing Address - Fax:248-858-2527
Practice Address - Street 1:1821 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4237
Practice Address - Country:US
Practice Address - Phone:248-858-2225
Practice Address - Fax:248-858-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X, 333600000X
MI53010030213336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No291U00000XLaboratoriesClinical Medical Laboratory
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177107OtherPK
MI2528957Medicaid