Provider Demographics
NPI:1508432543
Name:ANZABI, ILHAMA
Entity Type:Individual
Prefix:
First Name:ILHAMA
Middle Name:
Last Name:ANZABI
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 1:1582 CLARK DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4375
Mailing Address - Country:US
Mailing Address - Phone:267-210-9795
Mailing Address - Fax:
Practice Address - Street 1:5417 NESHAMINY BLVD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1782
Practice Address - Country:US
Practice Address - Phone:215-757-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045282R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist