Provider Demographics
NPI:1124627393
Name:ISAWI, SALEM
Entity type:Individual
Prefix:DR
First Name:SALEM
Middle Name:
Last Name:ISAWI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9430
Mailing Address - Country:US
Mailing Address - Phone:414-761-9571
Mailing Address - Fax:414-761-3106
Practice Address - Street 1:6701 S 27TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9430
Practice Address - Country:US
Practice Address - Phone:414-761-9571
Practice Address - Fax:414-761-3106
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16161-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist