Provider Demographics
NPI:1194077263
Name:TRABOULSI, HYDER K
Entity type:Individual
Prefix:
First Name:HYDER
Middle Name:K
Last Name:TRABOULSI
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 1:31 CANNON RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4237
Mailing Address - Country:US
Mailing Address - Phone:732-521-4660
Mailing Address - Fax:
Practice Address - Street 1:20 BRIDEWELL PL
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1724
Practice Address - Country:US
Practice Address - Phone:973-779-0189
Practice Address - Fax:973-779-0717
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI02256500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist