Provider Demographics
NPI:1073296745
Name:SOBBI, EISA HAMID (PHARMD)
Entity Type:Individual
Prefix:
First Name:EISA
Middle Name:HAMID
Last Name:SOBBI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5966
Mailing Address - Country:US
Mailing Address - Phone:208-320-4362
Mailing Address - Fax:
Practice Address - Street 1:2213 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5966
Practice Address - Country:US
Practice Address - Phone:208-320-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist