Provider Demographics
NPI:1669078770
Name:ABDULWAHED, FARAH
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:ABDULWAHED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 TREMONT ST APT 6K
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1105
Mailing Address - Country:US
Mailing Address - Phone:857-250-9509
Mailing Address - Fax:
Practice Address - Street 1:800 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199-1900
Practice Address - Country:US
Practice Address - Phone:617-880-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist