Provider Demographics
NPI:1245612274
Name:ABDELRAHMAN, AHMED (RPH)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ABDELRAHMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N ABE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6361
Mailing Address - Country:US
Mailing Address - Phone:325-658-3064
Mailing Address - Fax:
Practice Address - Street 1:12 N ABE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6361
Practice Address - Country:US
Practice Address - Phone:325-658-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist