Provider Demographics
NPI:1518558501
Name:FARANSSO, ANWAR YOUSIF
Entity Type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:YOUSIF
Last Name:FARANSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SILVER MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2310
Mailing Address - Country:US
Mailing Address - Phone:510-672-1034
Mailing Address - Fax:
Practice Address - Street 1:10650 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2620
Practice Address - Country:US
Practice Address - Phone:510-527-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist