Provider Demographics
NPI:1629511084
Name:ABOUABDOU, NADA
Entity Type:Individual
Prefix:
First Name:NADA
Middle Name:
Last Name:ABOUABDOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-4805
Mailing Address - Country:US
Mailing Address - Phone:609-344-2700
Mailing Address - Fax:609-344-6470
Practice Address - Street 1:1101 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-4805
Practice Address - Country:US
Practice Address - Phone:609-344-2700
Practice Address - Fax:609-344-6470
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03837600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist