Provider Demographics
NPI:1861223836
Name:ADAM, SULAFA MOHAMED SULIEMAN
Entity type:Individual
Prefix:
First Name:SULAFA
Middle Name:MOHAMED SULIEMAN
Last Name:ADAM
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 1:2532 BARTELT RD APT 2D
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2720
Mailing Address - Country:US
Mailing Address - Phone:319-512-4255
Mailing Address - Fax:
Practice Address - Street 1:2532 BARTELT RD APT 2D
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2720
Practice Address - Country:US
Practice Address - Phone:319-512-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist