Provider Demographics
NPI:1265213714
Name:ALAZZAWI, FAHAD
Entity type:Individual
Prefix:
First Name:FAHAD
Middle Name:
Last Name:ALAZZAWI
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 1:3368 WOODS MILL DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9318
Mailing Address - Country:US
Mailing Address - Phone:614-815-4343
Mailing Address - Fax:
Practice Address - Street 1:12910 STATE ROUTE 664 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8564
Practice Address - Country:US
Practice Address - Phone:740-380-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist