Abes Drug Store 102 LLC
Organization Active NPI Community/Retail Pharmacy · Roseville, MI
NPI 1366044018 · NPPES record last updated Nov 30, 2023
Key facts
- NPI
- 1366044018
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- ABES DRUG STORE 102 LLC
- Practice address
- 30695 Little Mack Ave Ste F
Roseville, MI 48066-1771 - Phone
- (586) 459-0836
- Fax
- (586) 571-0650
- NPI assigned
- Nov 9, 2020
- Organization subpart
- No
Authorized official
- Name
- Ramzi Kassem, PHARMD
- Title
- Partner
- Phone
- (313) 377-6623
Corporate family (same tax ID) 1
Practitioners 2
-
Maher Kassem Awada, RPH
-
Ramzi Kassem, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230208000206 | MI | Part B Supplier - Pharmacy | 7012389604 | Practice locations: Roseville, MI |
National Provider Directory
- Tax ID family
- Abe'S Drug Store
Locations
30695 Little Mack Ave
Ste F
Roseville, MI 48066
Phone (586) 307-5054
25141 Hoover Rd
Warren, MI 48089
Phone (586) 459-0836
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
30695 Little Mack Ave Ste F
Roseville, MI 48066-1771
Mailing address
13770 E 12 Mile Rd
Warren, MI 48088-3751
Phone (586) 459-0836
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5301013171 | Other | MI | PHARMACY LICENSE |
| 5315242183 | Other | MI | PHARMACY CONTROLLED SUBSTANCE LICENSE |
Other names
- Abe's Drug Store
Other providers in Roseville, MI
- A Daughter'S Touch Home Health Care LLC
- A Safe Place Clinical Counseling PLLC
- Natasha Aazami
- Veronica Mary Abbo
- Ameer Abdulrazzak
- Abes Drug Store 102 LLC
- Robert E Abrams
- Margot G Abundis
- Aaron N Achatz
- James Darryl Adamo
All providers in Roseville, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.