Provider Demographics
NPI:1114612108
Name:ABDALLAH, MONTAHA
Entity Type:Individual
Prefix:
First Name:MONTAHA
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4737
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-4737
Mailing Address - Country:US
Mailing Address - Phone:340-277-5715
Mailing Address - Fax:
Practice Address - Street 1:REMAINDER MATRICULATE
Practice Address - Street 2:#1
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-692-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455746183500000X
VI457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist