Provider Demographics
NPI:1710190269
Name:MAKSOUD, HOSSAM ABDEL
Entity Type:Individual
Prefix:MR
First Name:HOSSAM
Middle Name:ABDEL
Last Name:MAKSOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137-69 QUEENS BLVD.
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1845
Mailing Address - Country:US
Mailing Address - Phone:718-297-4424
Mailing Address - Fax:718-526-6104
Practice Address - Street 1:137-69 QUEENS BLVD.
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1845
Practice Address - Country:US
Practice Address - Phone:718-297-4424
Practice Address - Fax:718-526-6104
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist