Provider Demographics
NPI:1598361826
Name:ALJETAWI, ABDULRAHMAN RAHMAN (RPH)
Entity Type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:RAHMAN
Last Name:ALJETAWI
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 1:94 PANCAKE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3205
Mailing Address - Country:US
Mailing Address - Phone:862-400-7075
Mailing Address - Fax:
Practice Address - Street 1:1145 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2353
Practice Address - Country:US
Practice Address - Phone:973-900-6660
Practice Address - Fax:888-490-5575
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI038677001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03867700OtherRPH - NJ BOARD OF PHARMACY
NJ28RJ08667OtherIMMUNIZATION APPROVAL