Healthcare Provider Details

I. General information

NPI: 1003829961
Provider Name (Legal Business Name): FAUZIA HUSSAIN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE PHARMACY SERVICE #119
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

121 JOHN JAMES AUDUBON WAY
MARLTON NJ
08053-7225
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-4153
  • Fax:
Mailing address:
  • Phone: 856-719-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS30717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: