Provider Demographics
NPI:1538770185
Name:FARHOUD, HUSAM (PHARMD)
Entity type:Individual
Prefix:
First Name:HUSAM
Middle Name:
Last Name:FARHOUD
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 1:7413 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1925
Mailing Address - Country:US
Mailing Address - Phone:718-374-5750
Mailing Address - Fax:
Practice Address - Street 1:690 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3890
Practice Address - Country:US
Practice Address - Phone:718-374-5750
Practice Address - Fax:718-374-5751
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY066785OtherPHARMACIST LICENSE