Provider Demographics
NPI:1700327715
Name:ABU BAKER, ABDALLA
Entity Type:Individual
Prefix:
First Name:ABDALLA
Middle Name:
Last Name:ABU BAKER
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 1:7131 NC 73 HWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-9186
Mailing Address - Country:US
Mailing Address - Phone:479-295-6476
Mailing Address - Fax:
Practice Address - Street 1:7131 NC 73 HWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9186
Practice Address - Country:US
Practice Address - Phone:479-295-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist