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1972329985 NPI number — ABES DRUG STORE 102 LLC

NPI Number: 1972329985
Health Care Provider/Practitioner: ABES DRUG STORE 102 LLC

Information about “1972329985” NPI (ABES DRUG STORE 102 LLC) exists in 1972329985 in HTML format HTML  |  1972329985 in plain Text format TXT  |  1972329985 in PDF (Portable Document Format) PDF  |  1972329985 in an XML format XML  formats.

NPI Number : 1972329985 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972329985",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ABES DRUG STORE 102 LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "13770 E 12 MILE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WARREN",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48088-3751",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-459-0836",
    "MailingAddressFaxNumber": "586-571-0650",
    "FirstLinePracticeLocationAddress": "30695 LITTLE MACK AVE STE F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROSEVILLE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48066-1771",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-459-0836",
    "PracticeLocationAddressFaxNumber": "586-571-0650",
    "EnumerationDate": "11/25/2024",
    "LastUpdateDate": "11/25/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KASSEM",
    "AuthorizedOfficialFirstName": "RAMZI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PHARMD",
    "AuthorizedOfficialTelephoneNumber": "586-981-0901",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3336L0003X",
        "TaxonomyName": "Long Term Care Pharmacy",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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