Provider Demographics
NPI:1124103387
Name:ZAWAIDEH, JALAL NABIL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JALAL
Middle Name:NABIL
Last Name:ZAWAIDEH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3274
Mailing Address - Country:US
Mailing Address - Phone:248-280-6401
Mailing Address - Fax:248-280-6405
Practice Address - Street 1:1041 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3274
Practice Address - Country:US
Practice Address - Phone:248-280-6401
Practice Address - Fax:248-280-6411
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302031002OtherSTATE LICENSE