Provider Demographics
NPI:1679136139
Name:ALSHLOUL, HUSAMALDEEN (RPH)
Entity Type:Individual
Prefix:
First Name:HUSAMALDEEN
Middle Name:
Last Name:ALSHLOUL
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 1:14 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2827
Mailing Address - Country:US
Mailing Address - Phone:203-491-6914
Mailing Address - Fax:
Practice Address - Street 1:1040 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2212
Practice Address - Country:US
Practice Address - Phone:973-345-4242
Practice Address - Fax:973-345-3307
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03980600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist