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General NPI Number Information
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NPI Number | 1164240438
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Entity Type | Individual
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Provider Name | SUSAN AWWAD
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Gender | Female
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 8351 ANDERSON BLVD
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City | FORT WORTH
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State | TX
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Zip | 76120-3625
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Country | US
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Telephone | 817-459-4581
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Fax |
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Provider Business Mailing Address
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Address Line | 2312 VILLAGE CIR APT 1833
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City | BEDFORD
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State | TX
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Zip | 76022-6046
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Country | US
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Telephone | 513-293-4391
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 74127
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License Number State | TX
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