Healthcare Provider Details

I. General information

NPI: 1083348270
Provider Name (Legal Business Name): TAMARA SHAKER AL ISSO PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N 2ND ST
EL CAJON CA
92021-7243
US

IV. Provider business mailing address

4456 RESMAR RD
LA MESA CA
91941-6870
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-0761
  • Fax: 619-401-3435
Mailing address:
  • Phone: 619-277-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: