Provider Demographics
NPI:1205224862
Name:ABRAHAM, BESTIN
Entity Type:Individual
Prefix:
First Name:BESTIN
Middle Name:
Last Name:ABRAHAM
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 1:350 N. BLUEGROVE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146
Mailing Address - Country:US
Mailing Address - Phone:214-459-9922
Mailing Address - Fax:214-459-9923
Practice Address - Street 1:350 N. BLUEGROVE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146
Practice Address - Country:US
Practice Address - Phone:214-459-9922
Practice Address - Fax:214-459-9923
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist