Provider Demographics
NPI:1255068953
Name:REDWAN, HASSAN
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:
Last Name:REDWAN
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 1:1658 W BAKER RD STE C
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2283
Mailing Address - Country:US
Mailing Address - Phone:281-428-0009
Mailing Address - Fax:832-695-0005
Practice Address - Street 1:1658 W BAKER RD STE C
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2283
Practice Address - Country:US
Practice Address - Phone:281-428-0009
Practice Address - Fax:832-695-0005
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist