MEDICARE: MR. MAMDOUH A BAKHIT RPH

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	40379	TX

General Provider Information

NPI Number	:	1417956301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAMDOUH A BAKHIT RPH

Provider Business Mailing Address
First Line	:	11214 BANDIT TRAIL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-7153
Country	:	US
Telephone Number	:	281-304-0119
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 KELLEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1967
Country	:	US
Telephone Number	:	713-566-5136
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/08/2007

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