Provider Demographics
NPI:1093276024
Name:CISCO, DORCAS ABENA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:DORCAS
Middle Name:ABENA
Last Name:CISCO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1811
Mailing Address - Country:US
Mailing Address - Phone:510-783-0330
Mailing Address - Fax:
Practice Address - Street 1:243 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1811
Practice Address - Country:US
Practice Address - Phone:510-783-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist