Provider Demographics
NPI:1205657418
Name:EMEIRA, HADEER MAHMOUD MAHMOUD
Entity type:Individual
Prefix:
First Name:HADEER
Middle Name:MAHMOUD MAHMOUD
Last Name:EMEIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 N PROSPECT AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-7202
Mailing Address - Country:US
Mailing Address - Phone:216-816-4437
Mailing Address - Fax:
Practice Address - Street 1:136 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1606
Practice Address - Country:US
Practice Address - Phone:262-429-9429
Practice Address - Fax:262-429-9428
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23348541183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician