Healthcare Provider Details

I. General information

NPI: 1528608841
Provider Name (Legal Business Name): ABRAHAM ABDULSALAM PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 JACKMAN RD
TOLEDO OH
43613-3574
US

IV. Provider business mailing address

1838 CONE ST
TOLEDO OH
43606-4304
US

V. Phone/Fax

Practice location:
  • Phone: 419-475-9103
  • Fax:
Mailing address:
  • Phone: 740-277-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03438910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: