Provider Demographics
NPI:1568053015
Name:ABDALLA, MAHA (PHARMD, PHD)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:
Last Name:ABDALLA
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GOODYS LN STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1900
Mailing Address - Country:US
Mailing Address - Phone:865-288-5837
Mailing Address - Fax:
Practice Address - Street 1:400 GOODYS LN STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1900
Practice Address - Country:US
Practice Address - Phone:865-288-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist