Provider Demographics
NPI:1659643476
Name:JABER, RADWAN C (RPH)
Entity type:Individual
Prefix:
First Name:RADWAN
Middle Name:C
Last Name:JABER
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 1:4 VALLEY BEND CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5548
Mailing Address - Country:US
Mailing Address - Phone:240-476-5451
Mailing Address - Fax:301-474-4401
Practice Address - Street 1:121 CENTERWAY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1802
Practice Address - Country:US
Practice Address - Phone:301-474-4400
Practice Address - Fax:301-474-4401
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10438183500000X
VA0202007331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist