Healthcare Provider Details

I. General information

NPI: 1063243244
Provider Name (Legal Business Name): DIMA SAMEER AL SAMARNEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 PRESTON RD
PLANO TX
75093-5102
US

IV. Provider business mailing address

1929 PRESTON RD
PLANO TX
75093-5102
US

V. Phone/Fax

Practice location:
  • Phone: 972-713-5515
  • Fax: 972-713-5516
Mailing address:
  • Phone: 972-713-5515
  • Fax: 972-713-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: