Provider Demographics
NPI:1245585835
Name:EID, DALIA H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DALIA
Middle Name:H
Last Name:EID
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 CHEROKEE ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1278
Mailing Address - Country:US
Mailing Address - Phone:770-528-5651
Mailing Address - Fax:770-528-5949
Practice Address - Street 1:4075 CHEROKEE ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1278
Practice Address - Country:US
Practice Address - Phone:404-625-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1245585835Medicaid