Provider Demographics
NPI:1043672736
Name:GHOR, HUZEFA
Entity Type:Individual
Prefix:
First Name:HUZEFA
Middle Name:
Last Name:GHOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3628
Mailing Address - Country:US
Mailing Address - Phone:972-223-3134
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3628
Practice Address - Country:US
Practice Address - Phone:972-223-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist