Provider Demographics
NPI:1508485707
Name:HUMAIDEH, MAIS ANIS (RPH)
Entity Type:Individual
Prefix:
First Name:MAIS
Middle Name:ANIS
Last Name:HUMAIDEH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 HAMPTONRIDGE DR APT 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-1386
Mailing Address - Country:US
Mailing Address - Phone:561-635-9359
Mailing Address - Fax:
Practice Address - Street 1:4521 HAMPTONRIDGE DR APT 207
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-1386
Practice Address - Country:US
Practice Address - Phone:561-635-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist