Provider Demographics
NPI:1215573258
Name:REDWAN, GHADA
Entity Type:Individual
Prefix:
First Name:GHADA
Middle Name:
Last Name:REDWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13618 LAKESHORE WAY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3424
Mailing Address - Country:US
Mailing Address - Phone:832-243-9337
Mailing Address - Fax:832-243-9337
Practice Address - Street 1:1658 W BAKER RD STE C
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2283
Practice Address - Country:US
Practice Address - Phone:281-428-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist