Provider Demographics
NPI:1366044018
Name:ABES DRUG STORE 102 LLC
Entity Type:Organization
Organization Name:ABES DRUG STORE 102 LLC
Other - Org Name:ABE'S DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMZI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-377-6623
Mailing Address - Street 1:13770 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3751
Mailing Address - Country:US
Mailing Address - Phone:586-459-0836
Mailing Address - Fax:586-571-0650
Practice Address - Street 1:30695 LITTLE MACK AVE STE F
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1771
Practice Address - Country:US
Practice Address - Phone:586-459-0836
Practice Address - Fax:586-571-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5301013171OtherPHARMACY LICENSE
MI5315242183OtherPHARMACY CONTROLLED SUBSTANCE LICENSE