Healthcare Provider Details

I. General information

NPI: 1225663685
Provider Name (Legal Business Name): YOUSRA ABUASI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 S PACKARD AVE
CUDAHY WI
53110-2659
US

IV. Provider business mailing address

5740 S PACKARD AVE
CUDAHY WI
53110-2659
US

V. Phone/Fax

Practice location:
  • Phone: 414-483-5667
  • Fax:
Mailing address:
  • Phone: 414-483-5667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17257-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: