MEDICARE: ALI ATTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835C0207X	Compounded Sterile Preparations Pharmacist	74039	TX

General Provider Information

NPI Number	:	1033932207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI ATTA

Provider Business Mailing Address
First Line	:	6105 BEVERLYHILL ST STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-6715
Country	:	US
Telephone Number	:	832-487-9746
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 BEVERLYHILL ST STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-6715
Country	:	US
Telephone Number	:	832-487-9746
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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Directions to “ ALI ATTA ” Practice Location

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