Provider Demographics
NPI:1407578297
Name:HASSOON, SAFA (RPH)
Entity Type:Individual
Prefix:
First Name:SAFA
Middle Name:
Last Name:HASSOON
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 1:12000 BARRYKNOLL LN APT 118
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4647
Mailing Address - Country:US
Mailing Address - Phone:832-951-4401
Mailing Address - Fax:
Practice Address - Street 1:9002 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1431
Practice Address - Country:US
Practice Address - Phone:361-576-2132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist