Healthcare Provider Details

I. General information

NPI: 1487166013
Provider Name (Legal Business Name): ABDULRAHMAN ZIDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3806 AVENUE I STE 3
ROSENBERG TX
77471-3951
US

IV. Provider business mailing address

3806 AVENUE I STE 3
ROSENBERG TX
77471-3951
US

V. Phone/Fax

Practice location:
  • Phone: 281-762-2307
  • Fax: 346-857-0066
Mailing address:
  • Phone: 281-762-2307
  • Fax: 346-857-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: