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General NPI Number Information
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NPI Number | 1659660637
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Entity Type | Individual
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Provider Name | WESSAM ANIS KOUSSA SAAD BSC
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Gender | Male
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 2200 E EL MONTE WAY
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City | DINUBA
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State | CA
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Zip | 93618-9377
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Country | US
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Telephone | 559-591-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 5010 W DOUGLAS AVE APT. 101
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City | VISALIA
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State | CA
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Zip | 93291-7812
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Country | US
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Telephone | 559-802-3671
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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 | 65107
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License Number State | CA
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