Provider Demographics
NPI:1891104345
Name:HAMDAN, ALAA
Entity Type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:HAMDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6102 BIRKDALE VALLEY DR APT 333
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2599
Mailing Address - Country:US
Mailing Address - Phone:704-726-7902
Mailing Address - Fax:
Practice Address - Street 1:10048 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7135
Practice Address - Country:US
Practice Address - Phone:803-802-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14370183500000X
NC22796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist