Provider Demographics
NPI:1043781636
Name:SOULE-ABOU, ZAIDAT
Entity Type:Individual
Prefix:
First Name:ZAIDAT
Middle Name:
Last Name:SOULE-ABOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12154 BRITTINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-2212
Mailing Address - Country:US
Mailing Address - Phone:410-651-1133
Mailing Address - Fax:
Practice Address - Street 1:12154 BRITTINGHAM LN
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2212
Practice Address - Country:US
Practice Address - Phone:410-651-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist