Provider Demographics
NPI:1518773845
Name:ISSA, IMAAN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:IMAAN
Middle Name:
Last Name:ISSA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 CLIFF DR APT 7
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3039
Mailing Address - Country:US
Mailing Address - Phone:626-848-8268
Mailing Address - Fax:
Practice Address - Street 1:389 CLIFF DR APT 7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3039
Practice Address - Country:US
Practice Address - Phone:626-848-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist