Provider Demographics
NPI:1669299574
Name:TASISSA, HAWI (PHARMD)
Entity type:Individual
Prefix:
First Name:HAWI
Middle Name:
Last Name:TASISSA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 OLIVINE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-0220
Mailing Address - Country:US
Mailing Address - Phone:919-971-7489
Mailing Address - Fax:
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:919-971-7489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034447971835I0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835I0206XPharmacy Service ProvidersPharmacistInfectious Diseases