Provider Demographics
NPI:1063097657
Name:KADDOUH, HUSSEIN MOUSSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:MOUSSA
Last Name:KADDOUH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 REUTER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2262
Mailing Address - Country:US
Mailing Address - Phone:313-595-5307
Mailing Address - Fax:
Practice Address - Street 1:3749 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9809
Practice Address - Country:US
Practice Address - Phone:734-975-4675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302413253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist