Healthcare Provider Details

I. General information

NPI: 1982996005
Provider Name (Legal Business Name): MARIAN MAMDOUH ABDALLA HANN ELMALAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2011
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 SYCAMORE SCHOOL RD
FORT WORTH TX
76133-7805
US

IV. Provider business mailing address

2513 WILDWOOD WAY
KELLER TX
76262-8811
US

V. Phone/Fax

Practice location:
  • Phone: 817-346-4457
  • Fax:
Mailing address:
  • Phone: 216-235-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03329091
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: