Provider Demographics
NPI:1104265511
Name:INFINITY DRUGS LLC
Entity type:Organization
Organization Name:INFINITY DRUGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:THABET
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:313-743-4064
Mailing Address - Street 1:11521 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3050
Mailing Address - Country:US
Mailing Address - Phone:313-733-6098
Mailing Address - Fax:313-334-5094
Practice Address - Street 1:11521 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3050
Practice Address - Country:US
Practice Address - Phone:313-733-6098
Practice Address - Fax:313-334-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010101223336C0003X, 3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138705OtherPK
MI1104265511Medicaid