Provider Demographics
NPI:1639576770
Name:EISSA, ZEIN ELABDEEN ELBAGIR
Entity Type:Individual
Prefix:
First Name:ZEIN ELABDEEN
Middle Name:ELBAGIR
Last Name:EISSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ZEIN
Other - Middle Name:
Other - Last Name:EISSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4381 STURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1950
Mailing Address - Country:US
Mailing Address - Phone:703-209-0203
Mailing Address - Fax:410-651-3368
Practice Address - Street 1:12154 BRITTINGHAM LN
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2212
Practice Address - Country:US
Practice Address - Phone:410-651-1133
Practice Address - Fax:410-651-3368
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22781183500000X
DEAI-0004682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist