Provider Demographics
NPI:1336822485
Name:ELISSA, ZEINA
Entity Type:Individual
Prefix:
First Name:ZEINA
Middle Name:
Last Name:ELISSA
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 1:4110 WILLIAMS WAY BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-2502
Mailing Address - Country:US
Mailing Address - Phone:281-239-7071
Mailing Address - Fax:
Practice Address - Street 1:4110 WILLIAMS WAY BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2502
Practice Address - Country:US
Practice Address - Phone:281-239-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist