Provider Demographics
NPI:1518978139
Name:OBEIDALLAH, WALEED M (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALEED
Middle Name:M
Last Name:OBEIDALLAH
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 1:84 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2709
Mailing Address - Country:US
Mailing Address - Phone:973-249-6680
Mailing Address - Fax:973-389-2315
Practice Address - Street 1:84 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2709
Practice Address - Country:US
Practice Address - Phone:973-249-6680
Practice Address - Fax:973-389-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01809400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01809400OtherNJ LICENSE #