Provider Demographics
NPI:1841054129
Name:AL-NUSAIRAT, HIBA (RPH)
Entity type:Individual
Prefix:
First Name:HIBA
Middle Name:
Last Name:AL-NUSAIRAT
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 1:7717 CANFORD ST APT E
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-7753
Mailing Address - Country:US
Mailing Address - Phone:317-748-8820
Mailing Address - Fax:
Practice Address - Street 1:523 S STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2792
Practice Address - Country:US
Practice Address - Phone:317-831-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26030643A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist