Provider Demographics
NPI:1487204509
Name:HUSSAIN, MIR ABBAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIR
Middle Name:ABBAS
Last Name:HUSSAIN
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 1:387 AVALON DR SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2166
Mailing Address - Country:US
Mailing Address - Phone:330-565-6797
Mailing Address - Fax:
Practice Address - Street 1:5001 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1407
Practice Address - Country:US
Practice Address - Phone:330-847-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist