Provider Demographics
NPI:1760722896
Name:AMBE INC
Entity Type:Organization
Organization Name:AMBE INC
Other - Org Name:ABC DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KETANKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-877-6446
Mailing Address - Street 1:5446 LAPEER RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509
Mailing Address - Country:US
Mailing Address - Phone:810-877-6446
Mailing Address - Fax:810-877-6760
Practice Address - Street 1:5446 LAPEER RD
Practice Address - Street 2:UNIT - A
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509
Practice Address - Country:US
Practice Address - Phone:810-877-6446
Practice Address - Fax:810-877-6760
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-27
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
MI53010100383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2377744OtherNCPDP PROVIDER IDENTIFICATION NUMBER