Provider Demographics
NPI:1629603188
Name:DAGAMSEH, NISRINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NISRINE
Middle Name:
Last Name:DAGAMSEH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NISRINE
Other - Middle Name:
Other - Last Name:ESSARHYERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:169 ROLLING GRN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-8740
Mailing Address - Country:US
Mailing Address - Phone:860-538-8943
Mailing Address - Fax:
Practice Address - Street 1:308 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-1506
Practice Address - Country:US
Practice Address - Phone:860-829-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015067183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist