Healthcare Provider Details

I. General information

NPI: 1134810088
Provider Name (Legal Business Name): AWATIF ZINE EL ABIDINE PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 MARKET SQUARE DR
PRINCE FREDERICK MD
20678-3173
US

IV. Provider business mailing address

355 MARKET SQUARE DR
PRINCE FREDERICK MD
20678-3173
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5313
  • Fax:
Mailing address:
  • Phone: 410-535-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29195
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: