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General NPI Number Information
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NPI Number | 1750032892
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Entity Type | Individual
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Provider Name | AHMAD H IDRISS RPH
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Gender | Male
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 1672 S 9TH ST UNIT D
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City | MILWAUKEE
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State | WI
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Zip | 53204-3426
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Country | US
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Telephone | 414-375-6112
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Fax | 414-375-6113
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Provider Business Mailing Address
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Address Line | 7725 S SCEPTER DR APT 24
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City | FRANKLIN
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State | WI
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Zip | 53132-2260
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Country | US
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Telephone | 414-614-8354
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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 | 20636-40
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License Number State | WI
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