Provider Demographics
NPI:1285417238
Name:AL-BASSISI, EMAN (PHARMD, CSP)
Entity type:Individual
Prefix:
First Name:EMAN
Middle Name:
Last Name:AL-BASSISI
Suffix:
Gender:F
Credentials:PHARMD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 COLOMBO DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3080
Mailing Address - Country:US
Mailing Address - Phone:504-287-1355
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4710
Practice Address - Country:US
Practice Address - Phone:781-566-5066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist