Provider Demographics
NPI:1932456266
Name:MOUSSALLIE, GEORGE GHASSAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GHASSAN
Last Name:MOUSSALLIE
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 1:4711 N DALLAS RD APT B304
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-9328
Mailing Address - Country:US
Mailing Address - Phone:509-995-4626
Mailing Address - Fax:
Practice Address - Street 1:4711 N DALLAS RD APT B304
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-9328
Practice Address - Country:US
Practice Address - Phone:509-995-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60281593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist