Provider Demographics
NPI:1205230273
Name:HAIDAR, HUSSEIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:
Last Name:HAIDAR
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 1:4020 SECOR RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4273
Mailing Address - Country:US
Mailing Address - Phone:567-315-8780
Mailing Address - Fax:419-299-0030
Practice Address - Street 1:4020 SECOR RD UNIT A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4273
Practice Address - Country:US
Practice Address - Phone:567-315-8780
Practice Address - Fax:419-299-0030
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist