MEDICARE: ABDELAZIM WAHDAN

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	061431	NY

General Provider Information

NPI Number	:	1831558105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDELAZIM WAHDAN

Provider Business Mailing Address
First Line	:	PO BOX 286233
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-0012
Country	:	US
Telephone Number	:	347-788-2497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 OCEAN PKWY
Second Line	:	APT 3A
City	:	BROOKLYN
State	:	NY
Zip	:	11223-5439
Country	:	US
Telephone Number	:	347-788-2497
Fax Number	:

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	11/13/2023

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