Healthcare Provider Details

I. General information

NPI: 1114880002
Provider Name (Legal Business Name): MINA T HASABALLAH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MARROWS RD
NEWARK DE
19713-3701
US

IV. Provider business mailing address

204 ARROWWOOD DR
NEWARK DE
19713-2892
US

V. Phone/Fax

Practice location:
  • Phone: 302-369-2510
  • Fax:
Mailing address:
  • Phone: 302-357-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0016143
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: