Provider Demographics
NPI:1417453325
Name:HABNAEL INC
Entity Type:Organization
Organization Name:HABNAEL INC
Other - Org Name:GREEKTOWN PHARMACY & MINI MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HIWOT
Authorized Official - Middle Name:
Authorized Official - Last Name:FEKADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-759-7062
Mailing Address - Street 1:4501 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4416
Mailing Address - Country:US
Mailing Address - Phone:443-759-7062
Mailing Address - Fax:443-941-9011
Practice Address - Street 1:4501 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4416
Practice Address - Country:US
Practice Address - Phone:202-460-7703
Practice Address - Fax:443-941-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD362019100Medicaid