Provider Demographics
NPI:1205128014
Name:SALEH AZAB, MICHAEL TALAT (RPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TALAT
Last Name:SALEH AZAB
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 1:9307 MEADOWFIELD CT APT N
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2388
Mailing Address - Country:US
Mailing Address - Phone:804-901-1793
Mailing Address - Fax:
Practice Address - Street 1:520 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4223
Practice Address - Country:US
Practice Address - Phone:804-225-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist