MEDICARE: ABDALLAH HUSAM ABDALLAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP458038	PA

General Provider Information

NPI Number	:	1447031174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDALLAH HUSAM ABDALLAH

Provider Business Mailing Address
First Line	:	2141 SAINT ALBERTS CIR
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-6538
Country	:	US
Telephone Number	:	267-810-9506
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 E WYOMING AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-4532
Country	:	US
Telephone Number	:	215-621-6315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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