Provider Demographics
NPI:1801269030
Name:HUSSEIN, SUZANA FAREEN
Entity type:Individual
Prefix:
First Name:SUZANA
Middle Name:FAREEN
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANA
Other - Middle Name:
Other - Last Name:HUSSEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:138 CASSELMAN ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5422
Mailing Address - Country:US
Mailing Address - Phone:916-243-9723
Mailing Address - Fax:
Practice Address - Street 1:138 CASSELMAN ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-5422
Practice Address - Country:US
Practice Address - Phone:916-990-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist