Provider Demographics
NPI:1003229030
Name:EISSA, RIHAM
Entity Type:Individual
Prefix:
First Name:RIHAM
Middle Name:
Last Name:EISSA
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 1:505 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1133
Mailing Address - Country:US
Mailing Address - Phone:410-957-2311
Mailing Address - Fax:410-957-2060
Practice Address - Street 1:505 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1133
Practice Address - Country:US
Practice Address - Phone:410-957-2311
Practice Address - Fax:410-957-2060
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1241388OtherEMPLOYER ID