Provider Demographics
NPI:1073283057
Name:ABUDALOU, BASHAR
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:ABUDALOU
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 1:1932 HIDDEN KNOLL PL APT 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3780
Mailing Address - Country:US
Mailing Address - Phone:603-540-5839
Mailing Address - Fax:
Practice Address - Street 1:4222 NW CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8411
Practice Address - Country:US
Practice Address - Phone:919-377-0342
Practice Address - Fax:919-377-0349
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy