Provider Demographics
NPI:1578847653
Name:ABDALLAH, ALHASAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALHASAN
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2724
Mailing Address - Country:US
Mailing Address - Phone:646-244-8521
Mailing Address - Fax:
Practice Address - Street 1:9255 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5322
Practice Address - Country:US
Practice Address - Phone:201-854-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02913500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist