MEDICARE: DR. HISHAM I AL MOMATTIN PHARM.D MHSA

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	183500000X	Pharmacist	43366	TX
2	1835P1200X	Pharmacotherapy Pharmacist	43366	TX

General Provider Information

NPI Number	:	1366425662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HISHAM I AL MOMATTIN PHARM.D MHSA

Provider Business Mailing Address
First Line	:	5509 W 9TH AVE
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4130
Country	:	US
Telephone Number	:	806-341-8033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 S COULTER ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-1786
Country	:	US
Telephone Number	:	806-356-4000
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	09/11/2025

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