Provider Demographics
NPI:1275732224
Name:ABOULHOSN, SOAD MAE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SOAD
Middle Name:MAE
Last Name:ABOULHOSN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:SUSIE
Other - Middle Name:MAE
Other - Last Name:ABOULHOSN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2300 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1045
Mailing Address - Country:US
Mailing Address - Phone:304-357-4359
Mailing Address - Fax:
Practice Address - Street 1:2300 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1045
Practice Address - Country:US
Practice Address - Phone:304-357-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist