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General NPI Number Information
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NPI Number | 1184440745
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Entity Type | Individual
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Provider Name | MASOUMEH MACI BAKHTIARI
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Gender | Female
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Dates
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Enumeration Date | 11/28/2024
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 1296 ARRINGTON RD
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8683
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Country | US
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Telephone | 979-207-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 2338 HARVEY MITCHELL PKWY S APT 9201
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5187
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Country | US
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Telephone | 979-739-8517
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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 | 75027
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License Number State | TX
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