Provider Demographics
NPI:1740877679
Name:ALRADHI, ABDULLAH YASEEN IBRAHEEM (RPH)
Entity type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:YASEEN IBRAHEEM
Last Name:ALRADHI
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 1:100 VILLAGE CIRCLE WAY APT 421
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6132
Mailing Address - Country:US
Mailing Address - Phone:919-903-3586
Mailing Address - Fax:
Practice Address - Street 1:104 SHERRON RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9508
Practice Address - Country:US
Practice Address - Phone:919-227-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist