MEDICARE: DR. HEBA AWADALLAH PHARM.D.

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	014656	KY

General Provider Information

NPI Number	:	1528340734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEBA AWADALLAH PHARM.D.

Provider Business Mailing Address
First Line	:	4800 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-1707
Country	:	US
Telephone Number	:	502-491-8774
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-1707
Country	:	US
Telephone Number	:	502-491-8774
Fax Number	:

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

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	12/13/2011

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