Provider Demographics
NPI:1134715667
Name:ABOUMIRAH, ALAAELDIN
Entity type:Individual
Prefix:
First Name:ALAAELDIN
Middle Name:
Last Name:ABOUMIRAH
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 1:825 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6064
Mailing Address - Country:US
Mailing Address - Phone:203-238-0910
Mailing Address - Fax:203-238-0881
Practice Address - Street 1:825 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6064
Practice Address - Country:US
Practice Address - Phone:203-238-0910
Practice Address - Fax:203-238-0881
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239483183500000X
CT0015527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist