Provider Demographics
NPI:1063024081
Name:HIJAZI, ABDALLAH
Entity Type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:
Last Name:HIJAZI
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 1:31241 MOULIN AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-7028
Mailing Address - Country:US
Mailing Address - Phone:586-945-1394
Mailing Address - Fax:
Practice Address - Street 1:31241 MOULIN AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-7028
Practice Address - Country:US
Practice Address - Phone:586-945-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist