Provider Demographics
NPI:1275665127
Name:BISSETTE, MALISHA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MALISHA
Middle Name:
Last Name:BISSETTE
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 1:6912 WILLING WORKER RD
Mailing Address - Street 2:
Mailing Address - City:LUCAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27851-9593
Mailing Address - Country:US
Mailing Address - Phone:252-239-1301
Mailing Address - Fax:252-243-1223
Practice Address - Street 1:303 GREEN ST E BLDG A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4105
Practice Address - Country:US
Practice Address - Phone:252-243-1224
Practice Address - Fax:252-243-1223
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist