Healthcare Provider Details

I. General information

NPI: 1649795758
Provider Name (Legal Business Name): SHARIF ALI ABDEL JALIL PHARM. D., MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

281 LINCOLN ST PROVIDER ENROLLMENT
WORCESTER MA
01605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 508-421-1401
  • Fax: 508-421-1490
Mailing address:
  • Phone: 508-421-1401
  • Fax: 508-421-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1026026
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0014096
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: