Provider Demographics
NPI:1417563693
Name:ALALLAQ, HUSSEIN M (RPH)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:M
Last Name:ALALLAQ
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 1:14139 POTOMAC MILLS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4644
Mailing Address - Country:US
Mailing Address - Phone:703-492-4880
Mailing Address - Fax:
Practice Address - Street 1:12151 STALLION CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-6225
Practice Address - Country:US
Practice Address - Phone:703-883-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist