Provider Demographics
NPI:1518370444
Name:KUTTEH, ISSAM A
Entity Type:Individual
Prefix:
First Name:ISSAM
Middle Name:A
Last Name:KUTTEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 HORSESHOE PIKE
Mailing Address - Street 2:RITE-AID PHARMACY# 3768
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:610-873-3720
Mailing Address - Fax:
Practice Address - Street 1:1249 HORSESHOE PIKE
Practice Address - Street 2:RITE-AID PHARMACY# 3768
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-873-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-034169L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist