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General NPI Number Information
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NPI Number | 1972329985
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Entity Type | Organization
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Legal Business Name | ABES DRUG STORE 102 LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 30695 LITTLE MACK AVE STE F
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City | ROSEVILLE
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State | MI
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Zip | 48066-1771
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Country | US
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Telephone | 586-459-0836
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Fax | 586-571-0650
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Provider Business Mailing Address
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Address Line | 13770 E 12 MILE RD
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City | WARREN
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State | MI
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Zip | 48088-3751
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Country | US
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Telephone | 586-459-0836
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Fax | 586-571-0650
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Authorized Official
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Title or Position | CEO
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Name | RAMZI KASSEM
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Credential | PHARMD
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Telephone | 586-981-0901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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