Healthcare Provider Details

I. General information

NPI: 1205774718
Provider Name (Legal Business Name): EMAN SHAFIK KHALIFA GAD EL RAB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 ISLETA BLVD SW
ALBUQUERQUE NM
87105-5836
US

IV. Provider business mailing address

7504 DIXON RD SE
ALBUQUERQUE NM
87108-5357
US

V. Phone/Fax

Practice location:
  • Phone: 505-877-3130
  • Fax:
Mailing address:
  • Phone: 505-304-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007346
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: