Provider Demographics
NPI:1447508171
Name:DABIC, EMESE ELISABETH
Entity type:Individual
Prefix:
First Name:EMESE
Middle Name:ELISABETH
Last Name:DABIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CASSELMAN ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5422
Mailing Address - Country:US
Mailing Address - Phone:916-351-1807
Mailing Address - Fax:
Practice Address - Street 1:8900 GREENBACK LANE
Practice Address - Street 2:WALGRENS DRUG
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95622
Practice Address - Country:US
Practice Address - Phone:916-900-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist