Provider Demographics
NPI:1164299418
Name:ATALLAH, LOUSI N (RPH)
Entity Type:Individual
Prefix:
First Name:LOUSI
Middle Name:N
Last Name:ATALLAH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 W 17TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1503
Mailing Address - Country:US
Mailing Address - Phone:862-777-1447
Mailing Address - Fax:
Practice Address - Street 1:158 W 17TH ST APT 2
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1503
Practice Address - Country:US
Practice Address - Phone:862-777-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04335600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist