Provider Demographics
NPI:1417082579
Name:SHADA, ABDELHAMMED SABRI HAMID (RPH)
Entity Type:Individual
Prefix:
First Name:ABDELHAMMED
Middle Name:SABRI HAMID
Last Name:SHADA
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 1:870 CALLE LAS MARIAS
Mailing Address - Street 2:HYDE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4209
Mailing Address - Country:US
Mailing Address - Phone:787-763-9536
Mailing Address - Fax:
Practice Address - Street 1:870 CALLE LAS MARIAS
Practice Address - Street 2:HYDE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4209
Practice Address - Country:US
Practice Address - Phone:787-763-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist