Provider Demographics
NPI:1659012490
Name:EL-MALAH, YASSER M (RPH)
Entity Type:Individual
Prefix:
First Name:YASSER
Middle Name:M
Last Name:EL-MALAH
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 1:2711 MAGELLAN DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3143
Mailing Address - Country:US
Mailing Address - Phone:318-557-5880
Mailing Address - Fax:
Practice Address - Street 1:2711 MAGELLAN DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3143
Practice Address - Country:US
Practice Address - Phone:318-557-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist