Provider Demographics
NPI:1164651147
Name:ABOUJAWDEH, MARLA KAY (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:MARLA
Middle Name:KAY
Last Name:ABOUJAWDEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 N JONES BLVD
Mailing Address - Street 2:APT #5
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-8826
Mailing Address - Country:US
Mailing Address - Phone:913-486-7188
Mailing Address - Fax:
Practice Address - Street 1:113 1ST ST E
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1422
Practice Address - Country:US
Practice Address - Phone:319-895-6248
Practice Address - Fax:319-895-6991
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist