Provider Demographics
NPI:1114112182
Name:ZAWAIDEH, NABIL L (RPH)
Entity Type:Individual
Prefix:MR
First Name:NABIL
Middle Name:L
Last Name:ZAWAIDEH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 17 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6803
Mailing Address - Country:US
Mailing Address - Phone:586-977-3397
Mailing Address - Fax:
Practice Address - Street 1:2101 17 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6803
Practice Address - Country:US
Practice Address - Phone:586-977-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist