Provider Demographics
NPI:1700519121
Name:FOUDA, HOSSAM
Entity Type:Individual
Prefix:
First Name:HOSSAM
Middle Name:
Last Name:FOUDA
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 1:3475 PARKWAY VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-6857
Mailing Address - Country:US
Mailing Address - Phone:216-825-1052
Mailing Address - Fax:
Practice Address - Street 1:3475 PARKWAY VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-6857
Practice Address - Country:US
Practice Address - Phone:336-771-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist