Provider Demographics
NPI:1962925057
Name:TOSSOUN, IMAN IBRAHIM (RPH)
Entity type:Individual
Prefix:
First Name:IMAN
Middle Name:IBRAHIM
Last Name:TOSSOUN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20839 WEST ROSCOE BLV
Mailing Address - Street 2:CVS/CAREMARK
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306
Mailing Address - Country:US
Mailing Address - Phone:818-701-8911
Mailing Address - Fax:
Practice Address - Street 1:5309 RAMSDELL AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1924
Practice Address - Country:US
Practice Address - Phone:818-957-3488
Practice Address - Fax:818-957-3488
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA512981835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty