Provider Demographics
NPI:1992114946
Name:MOUSAD, EMAD (RPH)
Entity type:Individual
Prefix:DR
First Name:EMAD
Middle Name:
Last Name:MOUSAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CAMPUS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4374
Mailing Address - Country:US
Mailing Address - Phone:877-696-3375
Mailing Address - Fax:801-346-0130
Practice Address - Street 1:365 CAMPUS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4374
Practice Address - Country:US
Practice Address - Phone:877-696-3375
Practice Address - Fax:801-346-0130
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist