Provider Demographics
NPI:1477029114
Name:ESMAEL, WISAMELDIN (RPH)
Entity Type:Individual
Prefix:
First Name:WISAMELDIN
Middle Name:
Last Name:ESMAEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKE AVE APT 7A
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1871
Mailing Address - Country:US
Mailing Address - Phone:908-316-1457
Mailing Address - Fax:
Practice Address - Street 1:14 LAKE AVE APT 7A
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1804
Practice Address - Country:US
Practice Address - Phone:908-316-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03914100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist