Healthcare Provider Details

I. General information

NPI: 1154042075
Provider Name (Legal Business Name): IRIS KAMGUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E HEBRON PKWY
CARROLLTON TX
75010-4468
US

IV. Provider business mailing address

7951 COLLIN MCKINNEY PKWY APT 3088
MCKINNEY TX
75070-7828
US

V. Phone/Fax

Practice location:
  • Phone: 972-492-2151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70896
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: