Provider Demographics
NPI:1750857140
Name:ABU-MALLOUH, FEDA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FEDA
Middle Name:
Last Name:ABU-MALLOUH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 KERNAN LAKE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4295
Mailing Address - Country:US
Mailing Address - Phone:815-603-4864
Mailing Address - Fax:
Practice Address - Street 1:9525 CROSSHILL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5812
Practice Address - Country:US
Practice Address - Phone:904-248-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300548183500000X
FLPS57482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist