Provider Demographics
NPI:1225630296
Name:IBN SINA COMMUNITY CLINIC PHARMACY
Entity Type:Organization
Organization Name:IBN SINA COMMUNITY CLINIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BADRI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVASOLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:281-977-7462
Mailing Address - Street 1:11226 S WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099
Mailing Address - Country:US
Mailing Address - Phone:281-977-7462
Mailing Address - Fax:281-977-7472
Practice Address - Street 1:11226 S WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099
Practice Address - Country:US
Practice Address - Phone:281-977-7462
Practice Address - Fax:281-977-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty