Provider Demographics
NPI:1619259900
Name:AL-FDEILAT, ABDULLAH HUSSEEN (RPH)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:HUSSEEN
Last Name:AL-FDEILAT
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 1:75 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4025
Mailing Address - Country:US
Mailing Address - Phone:207-469-7030
Mailing Address - Fax:
Practice Address - Street 1:75 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4025
Practice Address - Country:US
Practice Address - Phone:207-469-7030
Practice Address - Fax:207-469-7035
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist