Provider Demographics
NPI:1194849653
Name:KAWAS-FORSTE, MARY JOSIE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOSIE
Last Name:KAWAS-FORSTE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13755 TRAIL STONE LN
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4829
Mailing Address - Country:US
Mailing Address - Phone:817-439-3577
Mailing Address - Fax:
Practice Address - Street 1:815 N O CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4510
Practice Address - Country:US
Practice Address - Phone:972-579-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1601-0068-6078-613183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician