Provider Demographics
NPI:1356669808
Name:NESHEIWAT, GHASSAN E (PHARMACIS)
Entity Type:Individual
Prefix:MR
First Name:GHASSAN
Middle Name:E
Last Name:NESHEIWAT
Suffix:
Gender:M
Credentials:PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 PAINTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3335
Mailing Address - Country:US
Mailing Address - Phone:714-521-6647
Mailing Address - Fax:714-521-6647
Practice Address - Street 1:8508 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3335
Practice Address - Country:US
Practice Address - Phone:562-945-7940
Practice Address - Fax:562-945-7940
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH47650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA07301992Medicare UPIN