Healthcare Provider Details

I. General information

NPI: 1881225159
Provider Name (Legal Business Name): SYED I USMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W PLEASANT RUN RD
LANCASTER TX
75146-1114
US

IV. Provider business mailing address

4106 COACHMAN LN
COLLEYVILLE TX
76034-3758
US

V. Phone/Fax

Practice location:
  • Phone: 469-297-5364
  • Fax: 972-332-3669
Mailing address:
  • Phone: 817-938-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number24375
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number24375
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24375
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: