Provider Demographics
NPI:1972256634
Name:ABUDAYEH, TARIK HASAN (RPH)
Entity type:Individual
Prefix:
First Name:TARIK
Middle Name:HASAN
Last Name:ABUDAYEH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FIRETHORN DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7849
Mailing Address - Country:US
Mailing Address - Phone:504-388-7932
Mailing Address - Fax:
Practice Address - Street 1:2001 CAROL SUE AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-4445
Practice Address - Country:US
Practice Address - Phone:504-366-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist