Provider Demographics
NPI:1427329689
Name:ABDALLA, MEDHAT (PHARMD)
Entity type:Individual
Prefix:
First Name:MEDHAT
Middle Name:
Last Name:ABDALLA
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:PO BOX 3125
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-0125
Mailing Address - Country:US
Mailing Address - Phone:609-317-5910
Mailing Address - Fax:
Practice Address - Street 1:3159 ROUTE 9 S
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1012
Practice Address - Country:US
Practice Address - Phone:609-465-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03293900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist