=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831240761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALIBAS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42969 7 MILE RD
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48167-2277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-344-7444
-----------------------------------------------------
Fax | 248-344-7570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42969 7 MILE RD
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48167-2277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-344-7444
-----------------------------------------------------
Fax | 248-344-7570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BASSAM HAMMOUD
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 248-344-7444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 5301006902
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------