MEDICARE: BILAL MOHAMMAD ABDALLAH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI04089500	NJ

General Provider Information

NPI Number	:	1164122719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILAL MOHAMMAD ABDALLAH PHARMD

Provider Business Mailing Address
First Line	:	17 AVE AT PORT IMPERIAL APT 427
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-7027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 MAIN ST STE 160
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5623
Country	:	US
Telephone Number	:	862-438-8549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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