Provider Demographics
NPI:1659660637
Name:SAAD, WESSAM ANIS KOUSSA (BSC)
Entity Type:Individual
Prefix:
First Name:WESSAM
Middle Name:ANIS KOUSSA
Last Name:SAAD
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 W DOUGLAS AVE
Mailing Address - Street 2:APT. 101
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-7812
Mailing Address - Country:US
Mailing Address - Phone:559-802-3671
Mailing Address - Fax:
Practice Address - Street 1:2200 E EL MONTE WAY
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-9377
Practice Address - Country:US
Practice Address - Phone:559-591-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist