Provider Demographics
NPI:1346572609
Name:ISHAK, ALAA A (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ALAA
Middle Name:A
Last Name:ISHAK
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 1:3990 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3334
Mailing Address - Country:US
Mailing Address - Phone:505-620-0339
Mailing Address - Fax:
Practice Address - Street 1:3990 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3334
Practice Address - Country:US
Practice Address - Phone:505-620-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist