Provider Demographics
NPI:1346593720
Name:NESHEIWAT, ISSA (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ISSA
Middle Name:
Last Name:NESHEIWAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17208 MOSS SIDE LN
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2914
Mailing Address - Country:US
Mailing Address - Phone:240-704-2663
Mailing Address - Fax:
Practice Address - Street 1:17208 MOSS SIDE LN
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2914
Practice Address - Country:US
Practice Address - Phone:240-704-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist