=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245733609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABE'S DRUG STORE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2018
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13770 E 12 MILE RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48088-3751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-250-2520
-----------------------------------------------------
Fax | 586-250-2565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7651 SCHAEFER RD
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-250-2520
-----------------------------------------------------
Fax | 586-250-2565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SALAM BASSAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-686-8666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 5301011341
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------