Healthcare Provider Details

I. General information

NPI: 1871199398
Provider Name (Legal Business Name): RUKAYAT A USMAN PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 N LEE TREVINO DR
EL PASO TX
79936-4522
US

IV. Provider business mailing address

14700 ORSTEN ARTIS AVE APT SUITE
EL PASO TX
79938-4669
US

V. Phone/Fax

Practice location:
  • Phone: 915-599-9000
  • Fax:
Mailing address:
  • Phone: 919-798-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: