Provider Demographics
NPI:1679963581
Name:ABOULSAOUD, PAKINAM
Entity type:Individual
Prefix:
First Name:PAKINAM
Middle Name:
Last Name:ABOULSAOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1251
Mailing Address - Country:US
Mailing Address - Phone:732-251-8202
Mailing Address - Fax:
Practice Address - Street 1:15 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1251
Practice Address - Country:US
Practice Address - Phone:732-251-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03687300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist