Provider Demographics
NPI:1568828788
Name:TOUSSI, FARROKH (RPH)
Entity Type:Individual
Prefix:
First Name:FARROKH
Middle Name:
Last Name:TOUSSI
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 1:14940 FLORENCE TRL
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4628
Mailing Address - Country:US
Mailing Address - Phone:952-432-7133
Mailing Address - Fax:952-432-7136
Practice Address - Street 1:14940 FLORENCE TRL
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4628
Practice Address - Country:US
Practice Address - Phone:952-432-7133
Practice Address - Fax:952-432-7136
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN852920500Medicaid
MN1250150041Medicare NSC