Provider Demographics
NPI:1619128519
Name:FOSSOUO, VANESSA E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:E
Last Name:FOSSOUO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SINDJEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1522
Mailing Address - Country:US
Mailing Address - Phone:978-697-0118
Mailing Address - Fax:
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:617-232-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27489183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist