Provider Demographics
NPI:1750032892
Name:IDRISS, AHMAD H (RPH)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:H
Last Name:IDRISS
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 1:7725 S SCEPTER DR APT 24
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-2260
Mailing Address - Country:US
Mailing Address - Phone:414-614-8354
Mailing Address - Fax:
Practice Address - Street 1:1672 S 9TH ST UNIT D
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3426
Practice Address - Country:US
Practice Address - Phone:414-375-6112
Practice Address - Fax:414-375-6113
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20636-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist