Provider Demographics
NPI:1942453972
Name:BENDAMKILA, ABDELWAHAD
Entity Type:Individual
Prefix:
First Name:ABDELWAHAD
Middle Name:
Last Name:BENDAMKILA
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 1:7626 MID TOWN RD
Mailing Address - Street 2:# 205
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:269-823-4804
Mailing Address - Fax:
Practice Address - Street 1:1701 M 139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6101
Practice Address - Country:US
Practice Address - Phone:269-823-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020343791835P0018X
WI14839-0401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist