Provider Demographics
NPI:1710596465
Name:HUSSEIN, NISREEN (RPH)
Entity Type:Individual
Prefix:
First Name:NISREEN
Middle Name:
Last Name:HUSSEIN
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 1:2655 CALLA LILY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5251
Mailing Address - Country:US
Mailing Address - Phone:414-204-0204
Mailing Address - Fax:
Practice Address - Street 1:1844 S 15TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3225
Practice Address - Country:US
Practice Address - Phone:414-999-0999
Practice Address - Fax:414-562-6888
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19762-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist