Provider Demographics
NPI:1992429096
Name:MOUSSADDA, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:MOUSSADDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18733 SW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7914
Mailing Address - Country:US
Mailing Address - Phone:305-431-1285
Mailing Address - Fax:
Practice Address - Street 1:9701 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4615
Practice Address - Country:US
Practice Address - Phone:305-273-1247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist