Provider Demographics
NPI:1598048928
Name:YOUSSEF, JOSEPH G (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:G
Last Name:YOUSSEF
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 1:4020 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2472
Mailing Address - Country:US
Mailing Address - Phone:321-254-7803
Mailing Address - Fax:
Practice Address - Street 1:4020 N WICKHAM RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2472
Practice Address - Country:US
Practice Address - Phone:321-254-7803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36187183500000X
NY046509-1183500000X
TN12291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist