Provider Demographics
NPI:1295459535
Name:FADUL, HIBATALLA Z (RPH)
Entity type:Individual
Prefix:
First Name:HIBATALLA
Middle Name:Z
Last Name:FADUL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 ROOSEVELT BLVD APT A101
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-3115
Mailing Address - Country:US
Mailing Address - Phone:765-430-3328
Mailing Address - Fax:
Practice Address - Street 1:12197 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3208
Practice Address - Country:US
Practice Address - Phone:703-478-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist