Provider Demographics
NPI:1306199989
Name:OBEIDAT, ALAA
Entity type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:OBEIDAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 STONEGATE DR
Mailing Address - Street 2:#207
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8910 INDIAN HILLS DR
Practice Address - Street 2:#100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4128
Practice Address - Country:US
Practice Address - Phone:402-551-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13843183500000X
IA21822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist