Provider Demographics
NPI:1093498263
Name:ELABED, AZAM M
Entity Type:Individual
Prefix:
First Name:AZAM
Middle Name:M
Last Name:ELABED
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 1:590 W TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3513
Mailing Address - Country:US
Mailing Address - Phone:215-736-9003
Mailing Address - Fax:
Practice Address - Street 1:590 W TRENTON AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-3513
Practice Address - Country:US
Practice Address - Phone:215-736-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist