Provider Demographics
NPI:1700664281
Name:SARSOUR, NEDAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:NEDAL
Middle Name:
Last Name:SARSOUR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 W BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-5562
Mailing Address - Country:US
Mailing Address - Phone:414-882-0427
Mailing Address - Fax:
Practice Address - Street 1:3201 E LAYTON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1402
Practice Address - Country:US
Practice Address - Phone:414-481-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22349-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist