Provider Demographics
NPI:1194036277
Name:SEBBANA, ELHASSAN
Entity Type:Individual
Prefix:MR
First Name:ELHASSAN
Middle Name:
Last Name:SEBBANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6847
Mailing Address - Country:US
Mailing Address - Phone:423-238-7724
Mailing Address - Fax:423-238-7802
Practice Address - Street 1:9307 LEE HWY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6847
Practice Address - Country:US
Practice Address - Phone:423-238-7724
Practice Address - Fax:423-238-7802
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist