Provider Demographics
NPI:1780860841
Name:ABDOU, KAMAL A (RPH)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:A
Last Name:ABDOU
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 1:1270 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3211
Mailing Address - Country:US
Mailing Address - Phone:212-560-9811
Mailing Address - Fax:212-560-9816
Practice Address - Street 1:1270 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3211
Practice Address - Country:US
Practice Address - Phone:212-560-9811
Practice Address - Fax:212-560-9816
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02117384Medicaid