Healthcare Provider Details

I. General information

NPI: 1003816083
Provider Name (Legal Business Name): HASS & NOUR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9413
US

IV. Provider business mailing address

11260 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9413
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-3921
  • Fax:
Mailing address:
  • Phone: 530-432-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY35940
License Number StateCA

VIII. Authorized Official

Name: HASSAN SARTAWI
Title or Position: OWNER
Credential:
Phone: 650-477-6352