Individual provider Active NPI

Ghada Abdallah, RPH

  • Pharmacist
  • Grosse Pointe Park, MI
National Provider Identifier
1740414903
Registry record updated Feb 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
5302032699 Issued in MI
Practice address
15126 Kercheval Ave
Grosse Pointe Park, MI 48230-1360
Phone
(313) 822-0100
Fax
(313) 822-0101
NPI assigned
May 3, 2009
Last updated
Feb 24, 2012By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 5302032699 MI Primary

Addresses

Primary practice location

15126 Kercheval Ave
Grosse Pointe Park, MI 48230-1360

Mailing address

15126 Kercheval Ave
Grosse Pointe Park, MI 48230-1360
Phone (313) 822-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
5302032699MIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Park Pharmacy Inc Current Accepting new patients
Park Pharmacy SCS LLC Current Accepting new patients

Locations

15126 Kercheval Ave
Grosse Pointe Park, MI 48230
Phone (313) 822-0100

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330041600000",
    "number": "1740414903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15126 KERCHEVAL AVE",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301360",
            "telephone_number": "313-822-0100",
            "fax_number": "313-822-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15126 KERCHEVAL AVE",
            "city": "GROSSE POINTE PARK",
            "state": "MI",
            "postal_code": "482301360",
            "telephone_number": "313-822-0100",
            "fax_number": "313-822-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABDALLAH",
        "first_name": "GHADA",
        "name_prefix": "Ms.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-03",
        "last_updated": "2012-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302032699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grosse Pointe Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.