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General NPI Number Information
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NPI Number | 1093347775
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Entity Type | Individual
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Provider Name | AHMED ABDULKAREEM ABBAS ALSARAH
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Gender | Male
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 13705 COVERED WAGON SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2286
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Country | US
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Telephone | 510-334-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 13705 COVERED WAGON SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2286
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Country | US
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Telephone | 510-334-0610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | PT00013720
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License Number State | NM
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