Provider Demographics
NPI:1225306855
Name:HUSSAIN, RAOUF (BSC, PHD, MBA)
Entity Type:Individual
Prefix:MR
First Name:RAOUF
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:BSC, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 COTTAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-8261
Mailing Address - Country:US
Mailing Address - Phone:435-655-7938
Mailing Address - Fax:
Practice Address - Street 1:2712 COTTAGE LOOP
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-8261
Practice Address - Country:US
Practice Address - Phone:435-655-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7022112-1701183500000X
CT9436183500000X
NV17633183500000X
ID6318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist