Provider Demographics
NPI:1174286603
Name:SHISHA, NOOR ABDULMASIH
Entity Type:Individual
Prefix:
First Name:NOOR
Middle Name:ABDULMASIH
Last Name:SHISHA
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 1:39725 CRYSTAL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2308
Mailing Address - Country:US
Mailing Address - Phone:586-229-9579
Mailing Address - Fax:
Practice Address - Street 1:39725 CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2308
Practice Address - Country:US
Practice Address - Phone:586-229-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist