Healthcare Provider Details

I. General information

NPI: 1396151072
Provider Name (Legal Business Name): FADY ABDLRASUL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14973 SOUTH AVE
COLUMBIANA OH
44408-9429
US

IV. Provider business mailing address

2300 TANGLEWOOD DR
SALEM OH
44460-2529
US

V. Phone/Fax

Practice location:
  • Phone: 330-482-3854
  • Fax:
Mailing address:
  • Phone: 330-831-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233854-2
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: