Healthcare Provider Details

I. General information

NPI: 1750058665
Provider Name (Legal Business Name): MOHAMMED MUGHRABI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 FM 1626
KYLE TX
78640-6038
US

IV. Provider business mailing address

5401 FM 1626
KYLE TX
78640-6038
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-7955
  • Fax:
Mailing address:
  • Phone: 512-268-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72955
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: