Provider Demographics
NPI:1932730736
Name:ABDELRAZZAQ, ALA F (RPH)
Entity Type:Individual
Prefix:
First Name:ALA
Middle Name:F
Last Name:ABDELRAZZAQ
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 1:36378 DOMINION CIR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7458
Mailing Address - Country:US
Mailing Address - Phone:317-590-4345
Mailing Address - Fax:
Practice Address - Street 1:36378 DOMINION CIR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-7458
Practice Address - Country:US
Practice Address - Phone:317-590-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302036823OtherSTATE LICENSE