Provider Demographics
NPI:1992976211
Name:DRUGSTORE MAX LLC
Entity type:Organization
Organization Name:DRUGSTORE MAX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TALITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGALAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-501-0926
Mailing Address - Street 1:9228 INDIANAPOLIS BLVD
Mailing Address - Street 2:7C
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2558
Mailing Address - Country:US
Mailing Address - Phone:219-595-0437
Mailing Address - Fax:219-595-0169
Practice Address - Street 1:9228 INDIANAPOLIS BLVD
Practice Address - Street 2:7C
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2558
Practice Address - Country:US
Practice Address - Phone:219-595-0437
Practice Address - Fax:219-595-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0540164323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1562013OtherNCPDP PROVIDER IDENTIFICATION NUMBER