Provider Demographics
NPI:1073208831
Name:JAMALUDDIN, ABBAS FADEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABBAS
Middle Name:FADEL
Last Name:JAMALUDDIN
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 1:6525 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1746
Mailing Address - Country:US
Mailing Address - Phone:313-784-3461
Mailing Address - Fax:
Practice Address - Street 1:6525 CHASE RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1746
Practice Address - Country:US
Practice Address - Phone:313-784-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415112183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist