Provider Demographics
NPI:1487407516
Name:ZAWAIDEH, ADAM NABIL
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:NABIL
Last Name:ZAWAIDEH
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 1:5901 N ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2007
Mailing Address - Country:US
Mailing Address - Phone:248-224-0525
Mailing Address - Fax:
Practice Address - Street 1:775 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2576
Practice Address - Country:US
Practice Address - Phone:586-751-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist