Provider Demographics
NPI:1104429471
Name:AZZAZ, ABDELHAMID
Entity type:Individual
Prefix:DR
First Name:ABDELHAMID
Middle Name:
Last Name:AZZAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14324 ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-7432
Mailing Address - Country:US
Mailing Address - Phone:712-303-0384
Mailing Address - Fax:
Practice Address - Street 1:950 E GREENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-8448
Practice Address - Country:US
Practice Address - Phone:765-584-3028
Practice Address - Fax:765-584-1330
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028654A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist