Provider Demographics
NPI:1972329985
Name:ABES DRUG STORE 102 LLC
Entity type:Organization
Organization Name:ABES DRUG STORE 102 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAMZI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:586-981-0901
Mailing Address - Street 1:13770 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3751
Mailing Address - Country:US
Mailing Address - Phone:586-459-0836
Mailing Address - Fax:586-571-0650
Practice Address - Street 1:30695 LITTLE MACK AVE STE F
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1771
Practice Address - Country:US
Practice Address - Phone:586-459-0836
Practice Address - Fax:586-571-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy