Provider Demographics
NPI:1205197522
Name:AMATULLAH AAI INC
Entity Type:Organization
Organization Name:AMATULLAH AAI INC
Other - Org Name:MS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULAMHUSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:832-698-1565
Mailing Address - Street 1:27721 TOMBALL PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6561
Mailing Address - Country:US
Mailing Address - Phone:832-698-1565
Mailing Address - Fax:832-698-4598
Practice Address - Street 1:27721 TOMBALL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6561
Practice Address - Country:US
Practice Address - Phone:832-698-1565
Practice Address - Fax:832-698-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX285553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135510OtherPK
TX146803Medicaid