MEDICARE: MICHAEL KHALAFALLA BAKHET YASSA

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	76869	TX

General Provider Information

NPI Number	:	1932050606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KHALAFALLA BAKHET YASSA

Provider Business Mailing Address
First Line	:	3352 LONE TREE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3352 LONE TREE LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-9476
Country	:	US
Telephone Number	:	817-513-2144
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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