Provider Demographics
NPI:1952609315
Name:BARSOUM, ISHAK E (PH)
Entity Type:Individual
Prefix:
First Name:ISHAK
Middle Name:E
Last Name:BARSOUM
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17069 S DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-7403
Mailing Address - Country:US
Mailing Address - Phone:302-398-4420
Mailing Address - Fax:302-398-7529
Practice Address - Street 1:17069 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-7403
Practice Address - Country:US
Practice Address - Phone:302-398-4420
Practice Address - Fax:302-398-7529
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist