Provider Demographics
NPI:1003210550
Name:ABDANAN, HAMID R (PHARMD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:R
Last Name:ABDANAN
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 1:129 GRAYLING WAY
Mailing Address - Street 2:
Mailing Address - City:INLET BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-9625
Mailing Address - Country:US
Mailing Address - Phone:469-774-8624
Mailing Address - Fax:
Practice Address - Street 1:129 GRAYLING WAY
Practice Address - Street 2:
Practice Address - City:INLET BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-9625
Practice Address - Country:US
Practice Address - Phone:469-774-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist