Provider Demographics
NPI:1801234463
Name:AL-HOUSSAYNI, REDDA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REDDA
Middle Name:
Last Name:AL-HOUSSAYNI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-1235
Mailing Address - Country:US
Mailing Address - Phone:213-536-4888
Mailing Address - Fax:213-539-4889
Practice Address - Street 1:2070 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-1235
Practice Address - Country:US
Practice Address - Phone:213-536-4888
Practice Address - Fax:213-539-4889
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52226OtherCALIFRONIA STATE BOARD OF PHARMACY