Provider Demographics
NPI:1003183369
Name:ATTALLA, EMAD N (RPH)
Entity Type:Individual
Prefix:
First Name:EMAD
Middle Name:N
Last Name:ATTALLA
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 1:913 MENNONITE RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3018
Mailing Address - Country:US
Mailing Address - Phone:484-542-0465
Mailing Address - Fax:610-962-9086
Practice Address - Street 1:119 E DEKALB PIKE
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2114
Practice Address - Country:US
Practice Address - Phone:610-962-9627
Practice Address - Fax:610-962-9086
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist