Provider Demographics
NPI:1225541451
Name:HISHMEH, MANAL H
Entity Type:Individual
Prefix:
First Name:MANAL
Middle Name:H
Last Name:HISHMEH
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 1:3350 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3024
Mailing Address - Country:US
Mailing Address - Phone:805-765-6046
Mailing Address - Fax:805-765-6088
Practice Address - Street 1:3350 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3024
Practice Address - Country:US
Practice Address - Phone:805-765-6046
Practice Address - Fax:805-765-6088
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist