Provider Demographics
NPI:1285000737
Name:RADWAN, MIRNA BAZ (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MIRNA
Middle Name:BAZ
Last Name:RADWAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12405 N GESSNER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1170
Mailing Address - Country:US
Mailing Address - Phone:832-912-2352
Mailing Address - Fax:
Practice Address - Street 1:12405 N GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1170
Practice Address - Country:US
Practice Address - Phone:832-912-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist