Provider Demographics
NPI:1629587571
Name:FARNOUSH, HOSSAIN MO (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:HOSSAIN
Middle Name:MO
Last Name:FARNOUSH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:HOSSAIN
Other - Middle Name:MOHAMMAD
Other - Last Name:FARNOUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR OF PHARMACY
Mailing Address - Street 1:3436 VETERAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5306
Mailing Address - Country:US
Mailing Address - Phone:562-282-2423
Mailing Address - Fax:
Practice Address - Street 1:4477 W 118TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2256
Practice Address - Country:US
Practice Address - Phone:310-675-6882
Practice Address - Fax:310-675-6893
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist