Provider Demographics
NPI:1639284763
Name:HUSSEIN, HUSSEIN A (RPH)
Entity Type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:A
Last Name:HUSSEIN
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 1:21710 BEECHCREST ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2405
Mailing Address - Country:US
Mailing Address - Phone:313-278-4315
Mailing Address - Fax:
Practice Address - Street 1:31505 32 MILE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-5215
Practice Address - Country:US
Practice Address - Phone:586-727-0090
Practice Address - Fax:586-727-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist