Provider Demographics
NPI:1144954462
Name:JABBAR, NADEN
Entity type:Individual
Prefix:
First Name:NADEN
Middle Name:
Last Name:JABBAR
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 1:31385 BEAR CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-1643
Mailing Address - Country:US
Mailing Address - Phone:619-332-7530
Mailing Address - Fax:
Practice Address - Street 1:25425 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1825
Practice Address - Country:US
Practice Address - Phone:586-757-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303037512183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician