Healthcare Provider Details

I. General information

NPI: 1043781636
Provider Name (Legal Business Name): ZAIDAT SOULE-ABOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12154 BRITTINGHAM LN
PRINCESS ANNE MD
21853-2212
US

IV. Provider business mailing address

12154 BRITTINGHAM LN
PRINCESS ANNE MD
21853-2212
US

V. Phone/Fax

Practice location:
  • Phone: 410-651-1133
  • Fax:
Mailing address:
  • Phone: 410-651-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26241
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: