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General NPI Number Information
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NPI Number | 1437753266
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Entity Type | Individual
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Provider Name | WISAM ELIA RPH
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Gender | Male
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 9665 CAMPO RD
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City | SPRING VALLEY
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State | CA
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Zip | 91977-1228
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Country | US
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Telephone | 619-466-4051
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Fax |
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Provider Business Mailing Address
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Address Line | 801 TAFT AVE
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City | EL CAJON
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State | CA
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Zip | 92020-6446
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Country | US
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Telephone | 540-309-8076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 83599
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License Number State | CA
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