Provider Demographics
NPI:1083348270
Name:AL ISSO, TAMARA SHAKER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:SHAKER
Last Name:AL ISSO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 RESMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6870
Mailing Address - Country:US
Mailing Address - Phone:619-277-6321
Mailing Address - Fax:
Practice Address - Street 1:215 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7243
Practice Address - Country:US
Practice Address - Phone:619-401-0761
Practice Address - Fax:619-401-3435
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist