Provider Demographics
NPI:1518650415
Name:FARDOUN, HASSAN FOUAD
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:FOUAD
Last Name:FARDOUN
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 1:2322 TEXAS AVE S
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4632
Mailing Address - Country:US
Mailing Address - Phone:979-696-5908
Mailing Address - Fax:
Practice Address - Street 1:2322 TEXAS AVE S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4632
Practice Address - Country:US
Practice Address - Phone:979-696-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist