Provider Demographics
NPI:1205881596
Name:BADR, HUSAM AHMAD (RPH)
Entity type:Individual
Prefix:MR
First Name:HUSAM
Middle Name:AHMAD
Last Name:BADR
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 1:121 SEABURY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3317
Mailing Address - Country:US
Mailing Address - Phone:864-233-9532
Mailing Address - Fax:864-233-2075
Practice Address - Street 1:1803 AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-2980
Practice Address - Country:US
Practice Address - Phone:864-233-9532
Practice Address - Fax:864-233-2075
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC734167Medicaid