Provider Demographics
NPI:1902115918
Name:GABALLA, HANY MOHAMED IBRAHIM (RPI)
Entity Type:Individual
Prefix:
First Name:HANY
Middle Name:MOHAMED IBRAHIM
Last Name:GABALLA
Suffix:
Gender:M
Credentials:RPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W BROOKHAVEN RD
Mailing Address - Street 2:APT # E 6
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-1841
Mailing Address - Country:US
Mailing Address - Phone:610-864-8420
Mailing Address - Fax:
Practice Address - Street 1:2722 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2043
Practice Address - Country:US
Practice Address - Phone:610-494-3910
Practice Address - Fax:610-494-5068
Is Sole Proprietor?:No
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARPI002295183500000X
PARP441957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist