Healthcare Provider Details

I. General information

NPI: 1881414001
Provider Name (Legal Business Name): IMAN ZIDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 INDEPENDENCE PKWY
PLANO TX
75075-9152
US

IV. Provider business mailing address

1112 LOMBARDY DR
PLANO TX
75023-7349
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-4422
  • Fax:
Mailing address:
  • Phone: 469-403-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number74885
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: